RESiDERM December'2022 issue

EXECUTIVE EDITOR & PUBLISHER

Dom Daniel

Editorial Board

Dr. R.D. Kharkar (MD, DVD)

Dr. Dr. Rajesh Rajagopalan (MD, DNB)

Dr. V. Mohankumar (MD)

Dr. Shrushti Jain Gupta (MBBS, DDV)

Dr. Harsh Tahiliani (MD-Skin & VD)

Dr. Ratnakar Shukla (MD, Senior Resident))

Dr. K. Revathi (MD, DVL)

Dr. D. Devi (MD,D.V.L Postgraduate)

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Published for the period of December 2022

PEARLS FOR THE YOUNG DERMATOLOGY RESIDENTS "

Dermatology being on top today, dermatology continues to be the most competitive residency to enter for several years now. With the strong academic background of dermatology residency applicants, there should be no lack of intellectual curiosity among the dermatology residents.

Dermatology residents are among the brainy, skillful and competent minds. Given a right platform, at the beginning of their career, they can showcase and accomplish in plenty. “RESIDERM” is one of such platform, where the residents can express themselves, without any restrictions, to the best of their ability. Exploring the way of dermatology residents at the beginning of their careers is crucial for their development and future identity.

Many a times, for a new resident, dermatology could be a perplexing subject. The aim of the “RESIDERM” is to provide the excellent guidance to residents for what decisions they make that influence their professional growth, as well as how they influence the educational environment for others such as medical students, peers, and the system. Therefore we bring you tips from esteemed and experienced faculty members. We hope you will enjoy reading the different kinds of interview, and it will help to choose the right direction of the speciality, encourage and inspired of this fascinating branch.

This issue we have the interesting topics for our beloved resident’s viz. interview with Senior Resident who has recently completed his residency and shared his 3 years resident journey, conversation with Second Generation Dermatologist, interview on START UP CLINIC, LAST WORD with great experience in Dermatology field and Clinical Case Discussion etc.

Hope you have a great read!

We are looking forward to your contributions for the next issue. Thanks & Cheers!

- Dom Daniel Executive Editor & Publisher

Female Genital Angiomyofibroblastoma: A Case Report and Review of the Literature

Dr.D. Devi MD, D.V.L

Postgraduate, Department of DVL

Government Erode Medical College and Hospital (GEMCH)

Perundurai, Erode, Tamilnadu

Dr. K. Revathi

MD, D.V.L

Assistant Professor Department of DVL Government Erode Medical College and Hospital (GEMCH)

Perundurai, Erode, Tamilnadu

Dr. V. Mohankumar

MD,

Associate professor, Department of DVL Government Erode Medical College and Hospital (GEMCH)

Perundurai, Erode, Tamilnadu

Dr. Rajesh Rajagopalan

MD, DNB

Head of Department, Department of DVL Government Erode Medical College and Hospital (GEMCH)

Perundurai, Erode, Tamilnadu

DU 40

Connecting Young Dermatologist

Dr. Srushti Jain Gupta

MBBS, DDV Consultant Dermatologist

Host Clinic Gwalior and Arogyadham Hospital, Madhya Pradesh

Interview With Senior Resident

Dr. Ratnakar Shukla MD (Dermatology) Senior Resident AIIMS, Gorakhpur

Next Generation

Dr. Harsh Tahiliani

MD - Skin & VD

Dermatologist, Dermatosurgeon, Cosmetologist

Dr. Tahiliani's Clinic

Mumbai, Maharashtra 17

Last Word

Dr. R. D. Kharkar

MD, DVD

Dr. Kharkar's Skin Clinic and Ziva Cosmetic Centre, Mumbai

Female Genital

Angiomyofibroblastoma: A Case Report and Review of the Literature

MD, DVL

Postgraduate

Department of DVL

Government Erode Medical College and Hospital (GEMCH)

Perundurai, Erode, Tamilnadu

MD, DVL

Assistant Professor

Department of DVL

Government Erode Medical College and Hospital (GEMCH)

Perundurai, Erode, Tamilnadu

MD

Associate professor

Department of DVL

Government Erode Medical College and Hospital (GEMCH)

Perundurai, Erode, Tamilnadu

MD, DNB

Head of Department

Department of DVL

Government Erode Medical College and Hospital (GEMCH)

Perundurai, Erode, Tamilnadu

Abstract

Angiomyofibroblastoma (AMFB) is a rare benign tumor of the female lower

genital tract. It is a mesenchymal tumor which characterized by Spindle Cells. We report a case of vulvar

Dr. D. Devi

Dr. V. Mohankumar

Dr. K. Revathi

Dr. Rajesh Rajagopalan

Female Genital Angiomyofibroblastoma: A Case Report and Review of the Literature

angiomyofibroblastoma. The positive diagnosis was made on the basis of morphology and histopathology. Tumors were treated surgically. It is important to differentiate AMFB from aggressive angiomyxoma because they have different treatment.

Keywords: Angiomyofibroblastoma, Mesenchymal tumors, Vagina

Introduction

Angiomyofibroblastoma is an uncommon benign mesenchymal tumor. It was described by Fletcher et al.[1] Several locations have been reported in the literature. The vulvovaginal area is the most frequent location. The other locations reported are fallopian tube, broad ligament and less frequently in the male genital tract.[2-4] This tumor is seen especially in patients with reproductive and perimenopausal age group.[5] The tumor is usually asymptomatic but patient can present pelvic discomfort, dyspareunia or vaginal bleeding. Physical examination usually finds a well-circumscribed elastic tumor typically sized <5 cm. Studies reported tumor size between 3 cm to 25 cm. Differential diagnosis includes both benign and malignant tumor. It is important to differentiate AMFB from Aggressive Angiomyxoma (AAM) because therapeutic care is different.

Case Presentation

A 29-year-old female came with complaints of single asymptomatic swelling over right side of the vulva since 3 and half years, and sexual discomfort and stress due to swelling for 3 years. She had history of excision for similar swelling 4 years back at the same site by suspecting Bartholin gland cyst. The biopsy showed features of AMFB. The patient again developed swelling at the same site 6 months following surgery. On examination right side vulva showed hyperpigmented swelling of size 6*4cm non tender, soft to firm, irregular with altered external genital architecture. Ultrasound revealed ill-defined heteroechoic lesion, mild increase in vascularity. MRI showed ill-defined heterogeneously T2 & STIR hyperintense lesion in right side vulva. Biopsy showed hypocellular and hypercellular areas and abundant blood vessels of various wall thickness plump of stromal cells and perivascular condensation in the stromal cells.

Discussion

AMFB is a rare pathology. Several reports analyzed the clinical, paraclinical and anatomo- pathological characteristics.Clinical symptoms are non-specific. Transvaginal Ultra sonography is the first choice.MRI is a sensitive examination but access is more difficult. It is recommended as a second line imaging. Computed Tomography (CT) is not recommended.[6]

AMFBs appear hyperechoic on perineal ultrasound with irregular and small hypoechoic cystic areas interspersed in homogeneous echogenic stroma.[7] AAM appears as a hypoechoic mass with homogenous echogenicity and occasional echogenic septa correlating to fibrous bands. The vascularization of the AMA is greater on the color doppler than AMFB. Most of the time MRI reveals a well circumscribed tumorhy pointense on T1 weighted images and hyperintense on T2 weighted images. Denomination AMFBs is based on the two components of this tumor: The blood vessels and stromal cells. Although most pathological characteristics of myofibroblast are lacking, the use of myofibroblastoma is justified because the tumor is desmin positive which is a reliable marker of myoid differentiation.

Histological features of AMFBs are spindle shape. They have a fascicular, wavy or palisade pattern, with areas of high and low cell density. They have also stromal proliferation of small vessels. Immunohistochemically, AMFB cells are positive for vimentin, desmine strogen receptor and progesterone receptor. But AMFB cells are negative for S-100 and ɑ-Smooth Muscle Actin (ɑ-SMA). Few cases of desmin-negative and ɑ-SMA-positive have been reported.

In our study, we report a case of vulvar AMFB showed characteristic histological features of angiomyofibroblastoma and positivity of stromal cells for estrogen and progesterone receptors.

We report several differential diagnoses of AMFB such as cellular angiofibroma, fibroepithelial stromal polyp or superficial angiomyxoma. These tumors are found at vulvovaginal area and represent a disease entity. AAM is the primary diagnosis to differentiate from AMFB.

Figure 1: Angiomyofibroblastoma of right vulva

Figure 2: Hypocellular and hypercellular areas and abundant blood vessels

Female Genital Angiomyofibroblastoma: A Case Report and Review of the Literature

They have the same clinical presentation. Differentiation between these tumors is important since treatment and prognosis differ. While AMFB needs a complete excision without additional therapy, aggressive angiomyxoma needs a wide excision and may require hormonal treatment because of its risks of infiltration and recurrency. AAM is a non-metastasizing tumor.

AAM cells are sparsely and densely distributed, without the characteristics of alternating density and aggregation around small blood vessels. However, AMFBs have higher cellularity more numerous blood vessels and more frequent plump or short spindle-shaped cells. AAMs are characterized by myxoid degeneration.

AAMs can also have positive for estrogen and progesterone receptors and positive expression of desmin. The expression of vimentin, desmin and CD34 in AMFB, suggest an undifferentiated mesenchymaltumor with preferential myofibroblastic differentiation. Large AMFBs are characterized by well-developed blood vessels. The risk is an important intraoperative blood loss. To reduce blood loss preoperative embolization was reported.

Conclusion

Angiomyofibroblastoma is a rare tumor that occurs mainly, but not exclusively, in the vulvovaginal region. Clinical findings and radiology may guide the diagnosis. Confirmation is based on histopathologic exam and immunophenotypic features. Differential diagnosis includes an array of pathologies but it is mostly important to differentiate it from AAM.

Acknowledgement

References

1. Fltcher CD, Tsang WY, Fisher C, Lee KC, Chan JK. Angiomyofibroblastoma of the vulva. A benign neoplasm distinct from aggressive angiomyxoma. Am J SurgPathol. 1992;16(4):373-82.

2. Sherif M, Mohamed I. Massive angiomyofibroblastoma of the glans penis. BMJ Case Rep. 2019;12(6):e229486.

3. Huang HC, Chen YR, Tsai HD, Cheng YM, Hsiao YH. Angiomyofibroblastoma of the broad ligament: A case report. Int J GynecolPathol. 2017;36(5):471-5.

4. Kobayashi T, Suzuki k, Arai T, Sugimura H. Angiomyofibroblastoma arising from the fallopian tube. Obstet Gynecol. 1999;94:833-4.

5. Canales BK, Weilland D, Hoffman N, Slaton J, Tran M, Manivel JC, et al. Angiomyofibroblastoma-like tumors (cellular angiofibroma). Int J Urol. 2006;13(2):177-9.

6. Eckhardt S, Rolston R, Palmer S, Ozel B. Vaginal angiomyofibroblastoma: A case report and review

of diagnostic imaging. Case Rep Obstet Gynecol. 2018;2018:7397121.

7. Wolf B, Horn LC, Handzel R, Einenkel J. Ultrasound plays a key role in imaging and management of genital angiomyofbroblastoma: A case report. J Med Case Rep. 2015;9(1):248.

Dr. Shrusti Jain Gupta MBBS, DDV

CONNECTING YOUNG DERMATOLOGIST DU 40

I wanted a clinical branch along with Dermatosurgery so I chose the branch I love and here I am!

My clinic completes me because it’s like my small baby! From dawn till twilight thinking and working for it!

“I want my private practice to be ONESTOP place for all Skin Problems.”

One thing I have learned from my small journey

“HARDWORK IS KEY TO SUCCESS”

For a female Dermatologist in INDIA it’s always a challenge to balance everything!

Every start has to go with its own problems. I have faced numerous problems; there are few I remember! Being a newcomer, first problem was TO GAIN TRUST

Eventually I have learned, Smile to problems and work hard! It will repay!

1. Tipping point in your dream to start your own private practice.

From childhood I wanted to be a doctor and used to dress up like a doctor with stethoscope. During my internship period I had worked with dedication in every department and observed thoroughly each department to decide which will suit me. After internship I was very clear with the branch I will choose either it will be Radiology or Dermatology. As I wanted a clinical branch along with Dermatosurgery I chose the branch I love and here I am!

2. Share your professional experience as a doctor. Not everyone is blessed to be in this world! Hence everyday I am thankful to God for choosing me as a means to serve patients. It feels so divine to see those happy tears for saving their loved ones! I would like to share one of my experiences; that still flutters in front of my eyes and which is very close to my heart! Two years back, a farmer had visited me with his teenage son with onion like huge nodulocystic acne grade 4. The human tendency is to say it’s “JUST ACNE”, but to my surprise, teenage was about to commit suicide for “JUST ACNE”! After treating his child; forget about money that you will earn any day but that gratitude of the gains, remains. Till date whenever the farmer passes

by he appreciates with those eyes for saving his son, this was my best achievement!

3. Which problems have you faced while starting up your private practice?

Every start has to go with its own problems.

I have faced numerous problems; there are a few I remember! Being a newcomer first problem was TO GAIN TRUST. Trusting newcomer is very difficult; its human tendency can’t help it! Gaining trust of patients as well as their family members is a difficult task!

Building trust, counselling well, diagnosing correctly will surely open path for success. Also I had been mocked many a times for sitting and waiting for long hours for patients!

Not bragging but now I have no time even for food; that too in just 2years!

So Smile to problems and work hard! It will repay!

4. What are the unique and different skills you should have, as a start-up doctor?

Well I think;

1) Diagnosing correctly

2) Counselling well

Dr. Shrusti Jain Gupta is Consultant Dermatologist at host Clinic Gwalior and Arogyadham Hospital, Madhya Pradesh.

DU 40 Connecting Young Dermatologist

3) Treating every patient in the same way, you will treat your family members

4) Don’t let your patient leave the room with a nonsatisfactory face

5) Try to be perfect and Aesthetic with your surgical skills

5. Have you always been successful or faced failure at some time in your career. Though I am person having patience but; repeated camp failures, repeated mocking had shattered my self-esteem many a times.

One thing I have learned from my small journey

“HARDWORK IS KEY TO SUCCESS” (we all know this common saying but very few follow it) I won’t say I am Successful but as a newcomer; surely my seniors and teachers are proud of my busy practise blast!

So yes, If that’s SUCCESS, then I am peanut size successful!!

6. Any instances where have you shown leadership and management skills not expected from a Dr. in your career?

Treating employees properly is one of the qualities a leader should have!!

Employees if treated arrogantly and mercilessly then they will just work out of fear but behind your back they will be grumpy and disrespectful.If you treat your employees well and consider their problems calmly and be polite to them, not only they will respect you behind your back but will work whole heartedly

7. What are the facilities you provide to your patients?

I practice PRP, Scar revision surgery, Minipunch graft for Vitiligo, Hair transplant, Botox, Fillers, Tattoo removal,ELR, Excision of sebaceous cyst, Granuloma, Staghorn, Lipoma, Warts, Molluscum, Lasers, Medipeel, Vampire facial, STD cases etc.

Today its either a Cosmetic Centre or Laser Centre or it’s purely Dermatology but I wanted to try to bring everything under one roof hence the name – HOST SKIN CLINIC (HOST-HOUSE OF SKIN TREATMENT)!!

I feel this is just a start, lot to learn, More to Advance!! I will Always be a Learner!!

8. When you started your clinic what was your clinics mission statement "I want my private practice to be............

In one line -

“I want my private practice to be ONESTOP place for all

Skin Problems”

9. What strengths are required to be a good start up Dermatologist?

They say there’s a woman behind every successful man but in my peanut size success story two men play a vital role – My Dad and My husband.

Both of them being constant Strength and Support!

Believing in oneself is the biggest power one could have! Confidence gives the ability to have a good start! My family is my biggest strength!

10. Any challenges faced and how you dealt with them (medical and personal)?

For a female Dermatologist in INDIA, it’s always a challenge to balance everything! As soon as I was done with my Post Graduation I had mind-set of working under Senior Dermatologist and then start my own clinic, but then I was advised to start on my own.

I took time to gain some confidence. Patience and sincere dedication played a huge role!

Hard work, sincerity, knowledge, patience plays significant role to deal with every phase of life!

11. How did you fund your start up clinic? Debt from banks, loans from family or personal savings? Your advise to Residents.

Well I feel I am still too young and a learner to advice anyone! But I would suggest to start with the basic machines; first study your target audience and then add machines one by one accordingly!

I had taken funds from my husband for my first laser machine! While the rest of the machines upgrade it through your own practice as it grows!!!

12. In your words "My clinic completes me because ............

My clinic completes me because it’s like my small baby! From dawn till twilight thinking and working for it!

Nothing gives me more satisfaction then this baby clinic!

Dr. Ratnakar Shukla MD (Dermatology) Senior Resident AIIMS, Gorakhpur

Interview With Senior Resident

INTERVIEW WITH SENIOR RESIDENT

I am a curious character and having an appetite for academic award and excellence. I am one of the luckiest person out of thousands and lakhs because I got the opportunity to help people, heal and treat them.

I'm loving myself and this process continues forever, no one can ever stop learning. Study hard, do your work honestly, keep working hard it will pay you back. Mantra of life is always stay calm. Be honest to your profession and yourself. Continue doing what you love to do and live your dream and be a great Dermatologist. Stay humble to your juniors, respect your seniors. Work hard, take care of your health. There is no better job satisfaction in this world when you can make a sad patient happy. When you can bring smile to someone's face or when you can cure their symptoms and make their life happy and healthy.

1. Introduce yourself

I am Dr. Ratnakar Shukla. I recently completed my post-graduation MD in Dermatology in June 2020, and currently I am working as a Senior Resident at AIIMS and I have a passion for academic excellence and interest in aesthetic and procedural Dermatology and love other extracurricular activities as well, including poetry, various sports and cultural activities.

2. Why did you choose to become a Dermatologist amongst other specialities?

Honestly speaking, I was not so sure about choosing Dermatology as a PG specialization during my UG days and at that time I was more attracted towards surgical branches, but when you grow up in MBBS you start getting more experience and you start getting to know much more about each specialization. So Dermatology in itself is a very unique branch as it is not only covers the medical aspect but it also has a lot of surgical and aesthetic procedure too. In addition, it has a very good work and life balance also if you have a good knowledge then there are good chances of earning well. That is why in last ten years it is one of the top most branch amongst the PG aspirants and having very few seats in the country when compared to other branches, it is mostly filled within the high rankers amongst the PG aspirants. Dermatology is a branch which not only heals you from within, but from outside as well. As in today's era people have become much more aware about how they look mainly because of the social media where one has to post pictures and all. So Dermatology is a branch

which not only treats your disease, but also makes you a better looking person.

3. What was your feeling while starting new specialization course?

Anxious, nervous and excited. It’s a kind of mixed feeling, a new place, new people and so many new things. So I just tried to acclimatize in this very new environment and started to explore the branch.

4. Did you feel any stress in starting days, did you settle immediately or took some time?

Yes initially, I was stressed out, as I already explained, when everything is new you will take some time to settle down and some time to get used to it and know everyone.

5. How was the teaching pattern, share your experience with new friends and professors?

Post-graduation is all about working and having discussion with your seniors and professors about the cases and all the other academic stuff .There is no classroom lectures so we discuss practical points about the cases with faculties and then faculties ask questions just to get the grip of our understanding.

6. Do you get enough time for studies, your batch cooperative in study?

It is difficult because most of the time you are in hospital doing clinical work. You also need time for your sleep and your daily routine activities, but it is worth mentioning that when there is a will there is a way, so one should

Interview With Senior Resident

always have a book in the bag and study whenever you get time and wherever it is possible, whether you are in OPD, whether you are in a procedure room, wards so whenever you get time just start studying and whatever the cases or anything important topic which you had discussed earlier or you had seen any important cases just try to study that case or that topic at least for 5-10 minutes whenever you get the time in a day. Even after doing your best it becomes hard to keep up with the pace.

7. What is your routine on a daily basis, did you face any challenges in daily routine?

So if I am on call resident then there is no daily routine I have to work till it finishes which has never happened, otherwise on off call day, by 8 am we should be in the ward on round and by 8:30 we have to attend morning discussions with the faculty and after that we have to do OPD work and procedure work till 4-5 pm and then again we have to go for the ward duty and by 6-6:30 we get free and if there’s no other work then we can head home.

8. Any message to the fresher’s for how to manage studies in 3 years?

So guys, don't stress out. Just listen to your seniors and faculties. Do your work honestly. There is no substitute to hard work. Observe the cases and just try to study a bit more about the cases you have seen in that day. In this way you are going to remember it. Try to study at least for an hour daily. Once you enter second year or third year residents then you get more and more time for your study. Keep working hard it will pay you back.

9. Did you receive any awards or scholarships that you have achieved for your hard work in your residency, list out if received.

Yes, I am a curious character and having an appetite for academic award and excellence. I do participate in quizzes and I have won at various state and national level, which includes PGCON, ONYCOCON, etc. In fact, in my department, my professor used to ask some difficult questions related to cases which we had observed in OPD and those who got the correct answers would receive an award in the form of small chocolates and I got more than 100 chocolates in my 3 years of residency.

10. Is there any incident during your residency program that you could never forget. If yes, then share with us.

There are many. But to highlight it here, I would like to state two incidents, first one is once being second year resident, I had diagnosed one very rare case on my own,

and my professor was so proud of me that he used to tell other faculty of different colleges that my student had diagnosed that particular case. So whenever memory of this incident flashes through my mind, it makes me feel proud about it. There is another incident when a patient was so happy that he waited for almost 4 hours for me though there were other co resident and faculties available, but still he waited for 4 hours just to get consulted by me and even though I was a resident, still he consulted me. This incident makes me happy even today, so these two incidents are the most memorable ones.

11. As you have finished your education share your dream from here? What are your plans, Private Practise/Academic/Work with a Dermatologist OR join a chain?

So at present I am associated with a premier Institute, AIIMS, and I'm having an interest for academic activity, which includes publication and presentation. So I will continue doing that and maybe in the coming year I will plan to open my own clinic as well to provide affordable, accessible, better and effective skin care to my patients.

12. Any specific achievements, disappointments during your residency?

To win National quizzes, to win trust of my patients which is of utmost importance to me. As far as disappointment is concerned, nothing specific, maybe if I was a little more aware then I could have done much more better things in my residency years.

13. During residency life did you have any pressure or excessive nervousness?

No. I am a very confident person and I stick to my decisions. So nothing as such. Only normal work pressure and on personal front I feel I am a calm, composed and relaxed person.

National Quiz Winner: Recieving Certificate

14. How to manage work-study- life balance?

See, there is always a room for everything. Study for at least one hour daily even that is enough if you are consistent, try to observe as many cases as possible. Each case will teach you something. Have a regular conversation with your family and friends. Take proper sleep, eat good food and enjoy the time. Whenever it is possible, spend sometime catching up with your friends and following your passion and hobbies.

15. What were your professional and personal difficulties?

As far as my professional life is concerned, sometimes, even though I want to do some procedure and I am pretty confident of doing it, but sometimes it is not approved by the faculty. So I am not able to do it. On personal front, I am a bit shy and introvert person so approaching someone was a bit difficult for me.

16. How important is the residents and faculty members relationship?

Yes, it is very important because a good environment flourishes one self and one can grow, whereas a negative environment can decrease the performance. And then one gets surrounded with the negative thoughts rather than concentrating on better and positive situations.

17. Any particular person who through your residency was supportive to you?

Many people, in fact my faculty, here I will name a few, Dr Nitin Nadkarni Sir, Dr.Sharmila Patil Ma'am, Dr. Kiran Godse sir, Dr. Manjot Gautam Ma’am, Dr Parag Sir, Dr Chirag Sir and Dr. Swagat Sir. You always develop a bond with few people for life that is beyond your college which includes my colleagues Dr. Nidhi and Dr. Sheena.

18. What was your research project, what did it involve and what type of support is needed to do a great job?

My research project was on Platelet-Rich-Plasma and its efficacy in Androgenetic Alopecia. It is an interventional study, so patient trust is very important.

19. Any problem or stressful situation you experienced during the residency then how to solve it give your opinion for junior?

Mantra of life is always to stay calm. However difficult the situation is, there is always a way, so always try to be as calm as possible.

Wo song h na -

“Haste gate yaha se guzar, Kal ki tu parwah na kar, Muskurate hue din bitana, Yha kal ka kya ho kisne jana”

Interview With Senior Resident

With HOD

Dr. Sharmila Patil

20. Now as a Dermatologist, what do you see as the positive and negative aspects of this specialty?

On the positive front, you have a great work and life balance. Not as much night calls as other core clinical branches like medicine, surgery and ortho doctors have. Another good point is that till date, no super specialization, so you can save those three years in setting up your life rather than going through NEET again. It has everything from surgical procedure to aesthetic procedure and it is one of the most rapidly evolving and developing branch. So it has a very good scope. On negative front, yes, you can say in general that people don’t appreciate your hard work as much as compared to cardiologist or orthopedics and neurosurgeon, etc.

21. Any message to your teachers and guide?

When a new-comer joins the department as resident, hold on to them, support them in every possible way because they are still adjusting in the new environment. As a new student, who always needs some time to adjust to the

With Dr. Jerry Shapiro

With Antonella Tosti

With Dr. Rachita Dhurat

With Dr. Rodney Sinclair

Interview With Senior Resident

new surroundings, building new places and connecting with people. Remember the time when you were student at one point. Treat them with respect and dignity.

22. Any message to the fresher’s? Can you be of any support to them and how?

You are going to start a new journey. There is going to be some good days and some bad days. It’s a process of learning, enjoy each and every moment. Be honest to your profession and to yourself. Study hard. There may be days when you feel low and depressed, but trust me, it will all pass. Continue doing what you love to do and live your dream and be a great Dermatologist. Stay humble to your juniors, respect your seniors. Work hard, take care of your health. Don’t be just another doctor, be the best one. Yes, I am available to all my young juniors who can approach me in whatever platform they like. I am available on Facebook, Instagram they can also connect with me through e-mail. They can ping me on my WhatsApp. They can call me on my number for any problem, suggestion or opinion whatever they want. I will try to give answer to them to the best of my capability.

23. Describe yourself -I am 1 of the lucky 1000 out of 12500

Yes I am one of the luckiest person out of thousands and lakhs because I got the opportunity to help people, heal and treat them, there is no better job satisfaction in this world when you can make a sad patient happy, when you can bring smile to someone's face or when you can cure their symptoms and make their life happy and healthy. I'm also loving myself and this process continues forever, no one can ever stop learning, there are so many new things to learn each day, we all are in the same boat sailing together. Never be shy to do hard work, there is no shortcut to success, do believe in yourself. Follow your dreams and passion.

Jail Camp Duty

Dr. Harsh Tahiliani MD - Skin and VD Dr. Tahiliani's Clinic

Mumbai, Maharashtra

NEXT GENERATION

I feel it’s a privilege to be a Second Generation Dermatologist as the advantages outweigh the expectations and comparisons from patients and peers.

A lot of guidance has been provided by my first generation regarding challenging cases, academics, clinic administration and maintaining a balance between professional and personal lives. Everyone goes through ups and downs in the practice of medicine.

I am lucky that my family understands this very well and they have always been there to provide emotional and personal support.

I believe I am happy with the way my practice and career has progressed since I started my post graduate training.

Dermatology is a very fascinating branch of medicine. Pursue this subject only if you have love for the subject and an appetite to work hard.

1. Share your story - Today you are the Dermatologist of Next generation in your family. As a kid, I always saw my parents as my role models and wanted to be just like them. I always worked my way through school with aspirations of becoming a doctor. Currently we have our own separate practices within the same setup and I feel proud that I have an opportunity to emulate them and also have the freedom to create my own niche in the practice of Dermatology.

2. This field of Dermatology was chosen by you on your own or under the pressure from your family of Dermatologists. There has never been any pressure from my family to make any career choices.

3. Your choice for Dermatology was derived from what type of interests and challenges found in your 1st generation of Dermatologists. Managing skin diseases is very challenging because of the chronicity and social stigma associated with many conditions. My interest and fascination was derived by seeing how gratifying it was to help patients treat and be at ease with their skin diseases.

4. How are you feeling being the 2nd generation doctor to enter the Dermatology field?

I feel grateful to be able to continue serving the community. I also feel it’s a privilege to be a Second Generation Dermatologist as the advantages outweigh the expectations and comparisons from patients and peers.

5. How is your relationship with your previous generation (Mother- Daughter/Son or Father –Daughter/Son)

Father/ son!

Dr. Harsh Tahiliani's Family

Dr. Sushil Tahiliani

Father of Dr. Harsh Tahiliani

Next Generation

6. Was any specific guidance in your career given by your first generation?

A lot of guidance has been provided by them regarding challenging cases, academics, clinic administration and maintaining a balance between professional and personal lives.

7. Which inspiration did you capture from your parent?

I have seen my parents working very hard with the same zeal and honesty, even today, after spending decades in the profession which inspires me a lot.

8. Without my parents being a Dermatologists I could not be a successful Dermatologist explain it…

Definitely it helps when your parents are from the same profession. My teachers and mentors have also played an important role in shaping my career.

9. Did you have any financial, personal and emotional support which you deserved?

Everyone goes through ups and downs in the practice of medicine. Patient outcomes are not always as expected and complications can occur even after the best efforts of any physician/surgeon.

I am lucky that my family understands this very well and they have always been there to provide emotional and personal support. Medicine also has a very lengthy and steep educational curve, doctors generally achieve financial independence only in their mid and late twenties.

10. How would you compare the differences between – Your father’s residency and your residency

We have done our residencies 35 years apart so there are many differences. Current residency programmes include training in procedural dermatology including surgeries, lasers, aesthetics apart from the core of clinical and diagnostic dermatology.

11. Today I am a successful Dermatologist of next generation. Your viewpoint…

I believe I am happy with the way my practice and career has progressed since I started my post graduate training. I hope I can continue to learn the science and art of this ever evolving subject and also share my knowledge with colleagues with the same enthusiasm for many more years and then reflect back.

12. Any motivational tips for the new and young Dermatologist

Dermatology is a very fascinating branch of medicine. Many health care professionals believe that the practice

of Dermatology is relatively easier as there are very few emergencies and more regulated working hours, we have our own share on challenges. Pursue this subject only if you have love for the subject and an appetite to work hard.

Dr. R D KHARKAR MD, DVD

LAST WORD

I worked initially for Leprosy and TB control through a voluntary organisation for first 12 years.

I have treated AIDS patients in early days when no physicians would treat them and hospitals too would refuse them.

I enjoy my work and have no Regrets.

Hard work and focus on practice will help you achieve all your goals. Do not go after money as it follows hard work so work hard and give your best.

1. A brief introduction of your PG days i.e from where etc?

I have done my Graduation and Post-graduation from Grant Medical College and J.J group of hospitals.

2. Did you have any Friend, Guide who mentored you?

Yes, Dr. R. G. Torsekar is not only a dear friend but also my guide and mentor.

3. Describe your initial activities, when you started your practice and today.

I worked initially for Leprosy and TB control through a voluntary organisation and started practicing in the evening for first 12 years after M D. Today life is totally different as I am focused only on Private Practice.

4. Describe your most successful accomplishments.

I have treated 18000 Leprosy and 12000 TB patients free of cost.

I have treated AIDS patients in early days when no physicians would treat them and hospitals too would refuse them.

I have published 38 National and International papers and got to visit many National and International conferences because of my research papers.

5. Share your experience and skills – I am what I am A Senior Dermatologist. As a senior Dermatologist ones out look towards disease changes and one can give better options based on experience. I get a lot of patients who come for a second opinion and with my vast experience I guide them correctly. Hence I can share my knowledge at different conferences.

6 Is there more to life than Dermatology. Yes. Pursuing hobbies, listening to music, vacationing with family.

7. Work life Balance - Joys, Regrets

I enjoy my work and have no Regrets. It’s really nice to hear patients say that they have got alright and are satisfied with my treatment in 1 to 2 visits.

8. What are the key challenges a Dermatologists faces today compared to when you started. Patients are more demanding and expect miraculous outcomes.

In a Tete-a-tete with Dr. R. D. Kharkar, shares his journey from Resident to highly respected, well regarded Senior Dematologist.

Dr. Kharkar's Skin Clinic and Ziva Cosmetic Centre, Mumbai

9. Any Hobbies you have cultivated and pursued?

Yes, listening to music, vacationing with family have been my leisure activities.

10. Today I am successful Dermatologist because I Love Dermatology

Hard work and attending conferences, gaining and sharing knowledge to others have helped me reach where I am today.

11. Any message to Residents - As a Senior Dermatologist

Patience is the key.

Patients teach you a lot and listening to them has a great impact on all of us.

Hard work and focus on practice will help you achieve all your goals.

Do not go after money as it follows hard work so work hard and give your best.