RESIDERM I July'2022 issue

Laugier–Hunziker Syndrome (LHS) In A Post-Menopausal Women

Dr. Farhat Khan

MD

Senior Resident Department of Dermatology, Topiwala National Medical College and BYL Nair Hospital, Mumbai

Dr. Hari Pathave

MD

Assistant Professor Department of Dermatology, KJ Somaiya Medical College, Mumbai

Dr. Chitra Shivanand Nayak

MD

Professor and HOD Department of Dermatology, Topiwala National Medical College and BYL Nair Hospital, Mumbai

Introduction/abstract

Laugier–Hunziker syndrome (LHS) is an acquired idiopathic macular hyperpigmentation of skin involving oral cavity frequently associated with longitudinal melanonychia. This benign disease mostly manifests in adults with no systemic features or malignant potential. Herein, we

present a classic case of LaugierHunziker syndrome in a postmenopausal woman.

Case report

A 46-year old female presented with history of blackish spots on lower lip, fingers, and toes which had developed gradually over last

one year. She also complained of linear blackish discoloration of finger nails. There was no history of pain or burning sensation in oral cavity. There was no history of any drug intake, exposure to radiation, or any trauma prior to the onset of pigmentation. Patient was a chronic tobacco chewer since 20 years. There was no history of similar pigmentation in early childhood or young age and no family member had similar skin disease. There was no history of abdominal pain, diarrhea, vomiting, rectal bleeding, blood stained vomiting, fatigue, hypotension or weight loss associated with the onset of pigmentation. Blood pressure was within normal limit and vitals were stable. Cutaneous examination revealed brown coloured macules of 1–4 mm in size on lower lip [Figure 1], on the palmar aspect of tip of the fingers with longitudinal melanonychia [Figure 2]. There was no darkening of the palmar creases. Similar pigmentation was seen on tip of toes. Some of the toe nails also showed longitudinal brownish black vertical bands 2-4 mm thick in size [Figure 3]. There was no periungual extension of the brownblack pigmentation. Serum cortisol level was normal. Gastrointestinal endoscopy did not show polyposis or any other abnormalities. General physical and systemic examinations were also normal. Biopsy was performed from the macule and nail bed of the left index finger, which showed relatively increased basal layer pigmentation with mild superficial perivascular lymphocytic infiltrate with sparse pigment incontinence (Figure 4 & 5). Patient was thus diagnosed as a classic case of LHS, which is a rare cause of oral and acral pigmentation.

Figure 1: Black to slate grey macules on oral mucosa.

Figure 2: Brown to black macules on finger tips and longitudinal melanonychia.

Syndrome (LHS) In A Post-Menopausal Women

Discussion

LHS was described initially in 1970 as an acquired, benign skin condition characterized by hyperpigmented macules on the lips and buccal mucosa associated with longitudinal melanonychia of nails.[1] It is considered a diagnosis of exclusion and primarily reported from European countries in white population, sporadic cases have been reported from Asia including India in last decade.[2] Oral hyperpigmentation may be the only presenting sign or may coexist with skin and nail pigmentation. The buccal mucosa and the lips (usually the lower lip) are the most commonly involved sites, but gingiva, tongue, soft palate, and the hard palate can also be involved. Nail pigmentation is in the form of thick vertical longitudinal bands. When LHS is associated with non-classic body locations or atypical features, the name idiopathic lenticular mucocutaneous hyperpigmentation has been used.[3] Extra-facial melasma has been associated with a peri-menopausal state,[4] but association of LHS like pigmentation and peri-menopausal or menopausal state is not yet reported. So far, only one case of familial LHS has been described, which involved a mother and two daughters.[5] Most reports of the histopathological changes in pigmented macules of LHS describe increased basal layer pigmentation in skin and mucosal lesions, but normal number and morphologic appearance of melanocytes. Important differential diagnosis of LHS include Peutz-Jeghers syndrome (PJS) characterized by mucocutaneous pigmentation with hamartomatous gastrointestinal

Figure 3: Longitudinal melanonychia of toe nails.

Laugier–Hunziker

Figure 4: Biopsy showing increased basal pigmentation, mild superficial perivascular lymphocytic infiltrate with pigment incontinence ( H & E, 10x).

Figure 5: Increased basal pigmentation with pigment incontinence (H & E, 40x)

Laugier–Hunziker Syndrome (LHS) In A Post-Menopausal Women

polyposis, which carries a high risk of malignancy.[6] Addison’s disease, which is characterized by hyperpigmentation of the skin in areas subject to increased pressure, is also an important differential diagnosis of LHS. Associated features include decreased pubic and axillary hair in women, dehydration, hypotension, and abdominal pain.[7]

Our patient had characteristic features of LHS. Patient was advised Q-switched Nd-Yag laser treatment for pigmentation, but she had no cosmetic concerns and refused treatment. Patient was reassured of the benign nature of the disease. The prognosis of the disease is good as there is no systemic illness or malignancy associated with LHS.

This case is being presented for its classical presentation that LHS and it can have late onset even in the fifth decade as in our patient.

References

1. Koch SE, LeBoit PE, Odom RB. Laugier–Hunziker syndrome. J Am Acad Dermatol. 1987;16:431–4. 2. Kanwar AJ, Kaur S, Kaur C, Thami GP. Laugier–Hunziker syndrome. J Dermatol. 2001;28:54–7.

2. Ajith C, Handa S. Laugier–Hunziker pigmentation. Indian J Dermatol Venereol Leprol. 2005;71:354–6.

3. Gerbig AW, Hunziker T. Idiopathic lenticular mucocutaneous pigmentation or Laugier–Hunziker syndrome with atypical features. Arch Dermatol. 1996;132:844–5.

4. Ritter CG, Fiss DV, Borges da Costa JA, de Carvalho RR, Bauermann G, Cestari TF. Extrafacial melasma: clinical, histopathological, and immunohistochemical case–control study. J EurAcadDermatolVenereol. 2013;27:1088–1094.

5. Makhoul EN, Ayoub NM, Helou JF, Abadjian GA. Familial Laugier-Hunzikersyndrome. J Am AcadDermatol. 2003;49:143–5.

6. Lampe AK, Hampton PJ, Woodford-Richens K, Tomlinson I, Lawrence CM, Douglas FS. Laugier–Hunziker syndrome: An important differential diagnosis for Peutz–Jeghers syndrome. J Med Genet. 2003;40:e77.

7. Shah SS, Oh CH, Coffin SE, Yan AC. Addisonian pigmentation of the oral mucosa. Cutis. 2005;76:979.

Dr. Shefali Trasi- Nerurkar

M.D. Dermatology

DU 40

CONNECTING YOUNG DERMATOLOGIST

"Own strengths, potential, patience and positivity, keep updating ones own knowledge and trying new things, newer technologies, remember failure is the first step to success, ability to handle Leadership and Management skills.

I want my private practice to be Famous for its good results. My clinic completes me because I love what I do.

Dr. Shefali is a young Dermatologist who joined Trasi’s Clinic as the 3rd generation Dermatologist in Trasi family. She has been trained in Cosmetology from reputed Institutes in Thailand and Europe. She has done fellowship courses in various Antiageing procedures. She has also obtained a fellowship in Lasers from the European institute of Laser Academy, Isreal. She also trains for doctors in Antiageing procedures.

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

My oldest dream which I remember was to become a doctor just like my parents and grandparent. So I knew I always wanted to start my private practice and help my mother in her clinic.

2. Share your professional experience as a doctor.

In my last 10 years of experience in private practice, I can definitely say that it wasn’t a smooth curve. Inspite of having a legacy of doctors, I had to struggle to create a name for myself. I had to find my strengths and weakness in my profession and work better on it. Slowly patients realised my potential and helped me build up my own practice.

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

While starting a private practice, the main problem for me was acceptability amongst the older staff from the clinic. Newer technologies were being introduced to make the clinic more efficient. Also I was a young Dermatologist so experience wise patients would prefer an older Dermatologist.

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

It’s extremely essential to find out ones own strengths. One can achieve success in a day. It takes a lot of patience and positivity to keep going. Start with basic things. Once, a patient base is setup, start investing in newer technologies one at a time.

5. Have you always been successful or faced failure at some time in your career. It’s an old saying that failure is the first step to success. If one has to become successful, one has to see failure before. However the trick is to keep running the race till one is satisfied with the results. Keep updating ones own knowledge and trying new things. Ask for help whenever required.

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

Leadership and management skills are required to start a private practice. It starts from choosing your staff, training them adequately. Retraining them at timely intervals. Hospitability and managerial skills are required right from how the patient should be first greeted on the phone while taking an appointment to finishing the treatment.

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

All Dermatology, Cosmetology, Antiageing and Body Contouring treatments are provided in the clinic.

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

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

Good knowledge of Dermatology and Cosmetic procedures. Good equipment along with it to give adequate results.

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

As a woman, it’s a challenge to strike a balance between home and clinic. It took me few years to manage my time adequately between both the places. Also the failures of results can also put our motivations low so to get back up and strike hard again is extremely important. Remember private practice is like giving an exam every single day.

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

Funding from banks or family is always better in the initial phase. The drive to fulfil the EMIs help us to grow more and work harder.

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

I love what I do.

Dr. Meera James

M.D. Dermatology

S ART UP INDIA S ART UP CLINIC

"Offer patients the right kind of service at the right cost. God given graceful ability to heal and cater to the needs of our patients…. so be patient, loving and caring and understanding towards them. Spend enough time with patients understanding their needs and wants. As a Dermatologist, practice should be oriented, guide the patients in the right direction. Treat the staff as part of our own family. My way to handle patients are professionalism and utmost care. Be really committed to the profession.

BE UNIQUE AND DIFFERENT. ..don't just follow the crowd…. be your own unique self and highlight your practice accordingly….

Dr. Meera James is one of the top Dermatologist in Ettumanur, Kochi. Founder of Beau Aesthetica Cosmetic Dermatology Clinic and Academy at Kochi, Kottayam and Thodupuzha Kerala. Beau Aesthetica offers a range of result-driven aesthetic treatments to suit all ages and skin types. Laser hair removal, cosmetic injectables, scar removal, tattoo removal, acne management, treatments for pigmentation, sun damage or just rejuvenation it’s all under the one roof.

Conversation with Dr. Meera James

1. When did you started practice? 2004

2. Reflect on your thoughts and experience.

Years back when I started my practice, Aesthetic Dermatology was still in its toddler phase...so we learned and grew together...there was ample time for us to understand the newer techniques and technologies and incorporate them in practice....but now the young Dermat getting fresh into practice is boarded with so many things leaving them confused as to what to incorporate into their practice..

3. Did you have financial, personal and emotional support while starting? No

4. I will never forget the first step to start my practice...... I wanted to have a practice where I can offer my patients the right kind of service at the right cost. The private hospital set up where I was working, didn't offer me that freedom. So I felt I should start on my own. The kind of opposition I had to face from the hospital where I was working to even with in my family was huge…I had to fight against so many odds to make my dream happen.

5. What are the challenges in developing the right practice management strategy?

Present day Aesthetics has become hugely a money making entrepreneurship. There is nothing wrong in making money, but there should be some ethics attached to it. How fast the money that had been invested can be got back...is the main concern of many a youngster starting fresh…

6. Ways to handling your professional responsibility and discipline...

Professionally we are living in challenging times as we are facing lot of competition from quacks and such set up springing around us every day. To be committed to our profession and delivering exceptional results with competence is the only way forward. Be the best in what you do and do it with exceptional skill.

7. How do you manage staff issues and complaints?

Staff happens to be the back bone of our practice and our clinical set up. So to have a successful as well enriching practice our staff needs to be happy and content. I treat them as part of my own family and take care of them as my very own, so that I know what is happening in their lives and can help them in times of need tackling their problems too.

8. My way to handle patients.......

Professionalism and utmost care. Be really committed to the profession.

9. Improving patient satisfaction is a very important step to increase the practice.

Always remember we are doctors, we are basically healers and it is a God given graceful ability to heal and cater to the needs of our patients…. so be patient, loving and caring and understanding towards them.

10. Patients counseling is the first part of practice management- My opinion. Spend enough time with patient understanding their needs and wants.

11. I take care of my patients to the best of my capability.

When a patient comes to my clinic they want to be treated by the doctor and not the staff. So whatever be the procedure, we always ensure that it is done by one of us doctors.

12. As a Dermat what is your duty towards your patients in clinical practice management.

In the present day so many fads are existing in this society and in the mindset of patients. As a Dermatologist, practice should be oriented in such a way as to make them understand their real value and what exactly is important and guide them in the right direction. And also help them in taking proper and rightful care of themselves and their needs. The instructions should be given such as to prevent the inadvertent use of fairness creams and steroidal creams.

13. What problems did you face while setting up your practice?

Setting up own practice all those years back wasn't easy at all. Finding out a proper place, naming the clinic getting the interiors done to even getting the first machine was a huge challenge. When I started in 2008, there wasn't any clinic in kerala which was specialized only in Cosmetic Dermatology. So it was a totally new enterprise. From designing the interiors to deciding about each and every aspect, I did on my own. But looking back I definitely feel happy ... now I have 2 more branches in two different

START-UP INDIA START UP

locations in kerala and an academy to train Dermatologists too, and I have shifted my clinic to a bigger as well own premises…. so even though arduous, the journey definitely had its merits.

14. Word of mouth publicity v/s Social Media engagement.

I am still an old world doctor, who believes in Word of mouth publicity more. There us a shelf life for social media gimmicks. If you are really good, then only you can survive through word of mouth publicity and that can be attained only if you are really committed to your job and do it with passion and skill.

15. Any advice for todays' Residerm, tomorrows Dermatologist.....

Be unique, be different...don't just follow the crowd…. be your own unique self and high light your practice accordingly….Don't just do what the rest of the world is doing..... BE UNIQUE AND DIFFERENT

16. How do manage patient’s satisfaction on a day to day basis in clinical practice. From designing your clinic to setting up your practice to even engaging your patients on a daily basis...do things differently but with compassion and commitment… don't just make money your lone driving force...

Beau Aesthetica, Kerala

DR. K. BHUMESH KUMAR

Human Personality and Communication Skills

Personality is the blend of Attitude, Behaviour, Physical Appearance and Intellect. It is the process of improving the personality by Self-discovery, Self-development, Selfactualization and Self-mastery. Body and Soul cannot be separated for treatment, they are one and indivisible. BE POSITIVE, create Happiness yourself. Self Confidence and high self-esteem are the key ingredients to your SUCCESS. Always develop POSITIVE ATTITUDE in YOUR LIFE.

If You Believe In Yourself, You Can Achieve Anything!

Dr. K. Bhumesh Kumar is a Pediatric Dermatologist and has an experience of over 19 years in the field. He completed MBBS from Gandhi Medical College, Hyderabad in 1994, Diploma in Child Health (DCH) from Gandhi Medical College, Hyderabad in 2000 and DVL from Gandhi Medical College, Hyderabad in 2007.

HUMAN PERSONALITY

Human personality is blend of mental, physical, spiritual and intellectual dimension of an individual. Human personality plays a vital role for our good health, happiness, success and progress.

[A]Physical dimension

Physical dimension focuses on visual aspect i.e. your physical appearance. Your healthy physique and physical appearance helps you to feel splendid. A balanced diet, sound sleep and regular physical exercise will assist you to improve and maintain physical health. Six elements required for health— 1.Air

1.AIR - Air is crucial for health. Oxygen is the most essential of all, without which we will die within minutes. Contaminants in the air are dangerous for health. The germs and polluted air cause the sickness. Poorly oxygenated cells cause serious diseases, including cancer.

Get more oxygen into body by deep breathing, meditating and exercising.

2.WATER - Water makes up to more than two thirds of the weight of the human body. The human brain is made up of 95% water, lungs of 90% water and blood comprises 82% of water.

Water plays a key role in the prevention of disease. Water serves as a lubricant, forms the base for saliva, forms the fluids that surround the joints, regulates the body temperature, helps to alleviate constipation and regulates metabolism. Drinking 8 glasses of water daily decrease the risk of colon cancer by 45%, bladder cancer by 50% and reduce the risk of breast cancer. Reverse osmosis water purification systems can remove 90-99% of all contaminants.

Mild dehydration- most common causes of daytime fatigue.

Contaminated water results in water borne diseases such as diarrhea, cholera, typhoid and parasite infections.

3. NUTRITION - Food in our diet provide the fuel and nutrition for every single function that is carried out in our body

A healthy diet is the key to overall good health. Balanced meal is necessary to keep fit and active. A combination of fats, minerals, proteins and carbohydrates as well as vitamins forms our daily diet.

Carbohydrates- 50% (energy) e.g. rice, sugar, honey etc.

Protein- 20-30% (building blocks) e.g. eggs, meat, fish, pulses, milk, nuts etc.

Fat- 10-15% (energy and insulation) e.g. oils, nuts, meats etc .

Vitamins and minerals e.g. fruits and vegetables.

4. EXERCISE - Exercise reduces the risk for several diseases like -

•Heart disease- Better blood cholesterol levels, boosts high-density lipoprotein (HDL), or “good” cholesterol while decreasing triglycerides.

•Adult-onset diabetes.

•Hypertension.

•Breast cancer, colon cancer.

•Osteoporosis.

•Improving your appearance.

•Better sleep patterns and emotional well-being.

•Dealing with a number of mental, emotional and psychological issues such as depression, anxiety, stress and other problems.

Research has also shown a direct link between immune system function and exercise. Regular physical activity can leave you feeling energized and looking better, which may have a positive effect on your sex life.

5.SLEEP - Sleep is also essential to stay alive. It is just as important as breathing. Sleep is our bodies’ way of

rejuvenating. One day of sleep deprivation cause alterations in mood, physical well being, and overall cognitive function. Increased periods of time without sleep results in negative changes into hallucinations, poor mental clarity, and often provoked disease, or even death. A continued lack of sleep can contribute to weight gain, anxiety, depression, lethargy and fatigue. A chronic, or pathological, sleep disorder will often result in an immune system deficiency. Many sleeping pills have adverse side effects, including trouble sleeping!

Studies show that the majority of fatal car crashes are directly correlative to lack of sleep. The average duration of sleep per day should be around eight hours.

Proper sleep boost your health, mood, and the quality of your life.

Some simple tips to a healthier sleep pattern•Eliminate caffeine in the afternoon and evening and few hours before bed.

•Exercising earlier in the day increases sleep regimen. •Anxiety and an overactive mind - practice deep breathing, meditation or prayer.

•Establish a routine. This will help balance the body’s internal clock and initiate the readiness and acceptance of sleep.

6. POSITIVE THINKING - Be positive, create happiness yourself. Body and soul cannot be separated for treatment, they are one and indivisible.

Anger is great enemy for health. For every minute you are angry, you lose sixty seconds of happiness.

Self confidence and high self esteem are the key ingredients to your success. Without self confidence

Positive Thinking

and self esteem one can never accomplish his/her goals. No one is born with self confidence or self esteem. Self confi-dence is created.

HUMAN PERSONALITY AND COMMUNICATION SKILLS

Successful people are not always successful. But they don’t focus on their failures. They create the self confidence that propels them to greater success.

The health benefits of positive thinking•Positive and optimistic people live healthier lifestyles.

•Increased life span, Lower rates of depression, distress, greater resistance to the common cold.

•Better psychological and physical well-being, Reduced risk of death from cardiovascular disease.

[B] Mental dimension

An individual with good mental ability is considered as an individual with good personality. Being optimistic, inculcating positive attitudes and habits is required to maintain mental health. The 3 C’s- Commitment, Control and Challenge help build self-esteem and promote positive thinking. Bring sim-ple, kind and forgiving one can make peace with the mind.

[C] Intellectual dimension

Intellectual dimension relates to critical thinking, reasoning and logical thinking for the betterment. Individual’s character, attitude, love and faith directly affect its intellect.

•Love is the lighting system of the face, healing system of heart and cooling system of head.

•There must be faith on humanity.

•Attitude of individuals depends on their education, environment and experience they have gained.

PERSONALITY DEVELOPMENT

Personal development is a life-long process. It has four distinct stages as follows:

[A]Self Discovery

‘Know thyself’ is an ancient classic theory that offers a reminder today as well. It is only through the discovery of self that we can identify our purpose and actualize our potential. We can start by reading self discovery books, embarking on a journey and embracing ourselves.

[B]Self Development

Self development is the process of consistently improving ourselves. It is a conscious pursuit of personal growth by improving personal skills. After discovering yourself, you need to make development by assessing you current skills, talents and competencies.

[C]Self Actualization

Self actualization is different than self discovery and self development. As you performance increases, you achieve more and more self confidence. An increased self confidence leads to being happier and more fulfilled in life. And you ultimately reach the self actualization and realization of your full potential.

[D]Self Mastery

Self mastery is the ability to recognize, understand, control and make the most out of your physical, mental, emotional and spiritual self. It is gained through awareness, understanding and control over your thoughts, emotions and actions.

COMMUNICATION SKILLS

Being able to communicate effectively is one of the most important skills. Communication skills are the abilities you use while giving and receiving different information. It involves listening, speaking, observing and empathizing.

It includes: [A]Verbal Communication

Verbal communication consist only 20% of the communication. It is further divided as oral communication and written communication.

Oral communication is speaking. The tone, volume and pitch of one’s voice contributes to effective communication.

Written communication is sending a message in writing through mail, letters, telegrams, manuals, etc.

[B]Non-verbal Communication

Non-verbal communication constitutes of the 80% communication. It is communication between people through non-verbal or visual cues. This includes gestures, facial expressions, body movement, timing, touch, and anything else that communicates without speaking.

SUMMARY

A person with a pleasing personality and good communication skills is appreciated and respected by all. Personality is the blend of attitude, behavior, physical appearance and intellect. Personality development is the process of improving the personality by self discovery, self development, self actualization and self mastery. Personality development helps individual to groom it, make a mark, reduce stress and conflicts and develop positive attitude in life. One can use the strategic plan of SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis. It is a good way to examine positive and negative attributes.

Dr. Satish Udare

M.D.,

LAST WORD

I am fortunate that lot of new things came in dermatology and I grabbed it with both hands. I went to remote places far away to practice, travelled lot, met people and diagnosed patients. I am still doing patient oriented practice and even when I travel

I am worried that I am leaving my patients alone e to suffer. Balance your life and practice well.

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

AIt all started when decision was made that it is better to do PG than remain as GP. It was my colleague who insisted that I fill the form. The choice was Dermatology or Pediatrics, could have got either but thought Dermatology is easy, may not need big establishment. My father already had announced that ‘I gave you basic education and now on you decide what to do further on your own’, he had already retired. So I decided to do dermatology- where one can practice with chair, table, pen and prescription pad. In indoors usually, no big equipment needed!

Well, I was lucky to work as resident in cooper hospital where we had OPD of 300-400 patients. We also used to go to KEM in morning and finish our OPD in afternoon; in turn we saw huge number of patients with plethora of different dermatosis, which eventually helped to gain tons of experience in diagnosing and managing skin diseases. The task was fast, easy and most of the times accurate.

Did you have any friend or guide who mentored you?

I must mention that all my seniors were helpful guides apart from my teachers Dr. R J Fernandez and Dr. P. D Gupte. Nobody at that time was really a mentor but all those seniors, teachers around you really helped in all the matters. And I owe them my success today. I always maintain that recently passed senior is best to tag, who will push you up. But really speaking ‘registrars’ post in KEM improved my personality, language, knowledge and clinical acumen.

Describe your day to day activities, priorities and tasks when you started your practice and today. When I started practice I never wanted to fall in rut of modern ways of practice and I opted area which was new, Navi Mumbai. Everything was new- practice, people, place and it were really difficult and frustrating initially. Then I joined lot of charitable clinics-mind you all new bees it continues to sharpen your clinical skills even after your college days and also gives you little financial help. I went to remote places far away to practice, travelled lot, met people and diagnosed patients.

Slowly as one local practice evolved, I gradually “stopped my peripheries and had time to establish new things including buying your own place-clinic, lasers and other machines, and even started a group practice with friends”. I am fortunate that lot of new things came in dermatology and I grabbed it with both hands.

Describe your most successful accomplishments. I got opportunity to teach in medical college which made me still better, as teacher I kept on sharpening my skills and acumen, so that I also became better teacher, to make my students even better. I really believe ‘shishyat ichheth parajayam’; i.e. your students should be so good that they become better even than you.

Soon the small clinic I bought on my own got expanded recently. Now I have four juniors who come to learn and help. Many come learn and start on their own. I want them to become good dermat and good humans like me. Once patient after waiting for 2 hour exclaimed, “why don’t you clone yourself!” well I am trying to create better than that.

But yes still lot to do and most successful accomplishment probably is yet to come.

Dr. Satish Udare has done his MBBS and MD from Seth AS Medical College and KEM Hospital. Professor at MGM Medical College. Former President and Secretary IMA, Navi Mumbai, Former President and Secretary IADVL Maharashtra Branch and Workshop Coordinator and National Faculty for Lasers and Dermatosurgery. He has also presented his papers in National Journals.

In a Tete-a-tete with Dr. Satish Udare, shares his journey from Resident to highly respected, well regarded Senior Dermatologist.

"Still long way to go and lots of things to do"

What I am today is good clinician to start with. Basically, empathic physician who cares for patients in there sufferings physically, spiritually, mentally and financially.

Share your experience and skills – I am what I am - A Senior Dermatologist. I have acquired skills in Cosmetology surgery lasers and Aesthetic Dermatology. Even hair transplants, I did few to master the technique and then moved on.

What probably I miss is chance to do basic research, due to my busy practice and family duties and laziness. Never did it as post graduate student, so no habit and the major thing I regret. But I encourage my juniors to do it.

A difficult situation you handled in your practice OR personally which had an influence on you.

There are always difficult situations in practice. Unsatisfied, quarrelsome, body dimorphic patients. Patients who get worsened for no reasons, drug reactions. Vasovagal shocks which make you miss your heartbeats. But one thing in practice I always say be patient, calm and composed all the time and remember –“You cannot satisfy everybody every time”.

Is there more to life than Dermatology? Any Hobbies you have cultivated and pursued. Yes there is and always will be more than Dermatology. But due to all these commitments it was difficult to excel in all these. But I did act in few dramas, managed to write few books both in subject and in literary world, because of conferences I had opportunity to travel, and nurture my hobby of photography. I sing merrily, play tabla, acted in drama but could not excel in that. Played Bridge -a card game - win a tournament or two, but again had time restrain. So I did do some balancing act too, but must confess that it was always tilted more toward practice of Dermatology. I did and still doing patient oriented practice and even when I travel I was worried that I am leaving my patients alone to suffer.

What are the key challenges a Dermatologists faces today compared to when you started. Today the life is different for a new comer. There is more competition. More presence of social media which has both good and bad influences, gone are the days when doctors were considered god. To acquire a place to stay and practice is becoming difficult, everybody wants to settle in big city where the opportunities are supposed to be better, but I tell my juniors everything is available everywhere, one will establish faster in small cities and even do research there.

What were the challenges you faced to get to where you are now?

Challenges faced are mainly related to finance. I wish I could buy best of machines have big place, do lot of clinical and basic research and give my patients still better care, cure and even aesthetic improvements.

How would your family describe you? Alas! My family thinks I am a good doctor but did give more attention to practice; my wife says that my first love is practice and then her. But when children were small I was there for them, though now I am busy but so is everybody in family.

I want my patients to describe me as dependable Dermatologist whom they can trust, most of them I believe say so but.

Work life Balance - Joys, Regrets

I have already said about my hobbies in balancing my life. Let’s hope I finish my writing and photography projects soon. I have learned many languages and want to excel in that and read and translate literature from different languages.

Today I am successful Dermatologist because........ Today am I successful? Let’s put some criteria to define that and answer will be yes/no?

Any message to Residents - As a Senior Dermatologist. Well message isDermatology is wonderful subject, lots of new things happening. Aesthetic dermat is booming enjoy that too. Get your knowledge and skills sharpen. Keep up-to-date., but do not forget your basics. Decide whether you want to treat your patients or want to satisfy your clients, or sometime balance both.

I Love Dermatology................... Money, name and fame will follow if you do your stuff with

empathy and skill. Balance your life and practice well. Given a choice I would still like to become a Dermatologist.

How would you like your patients to describe you? Dr. Udare is................