My Rheum Is A Dismissive Idiot

[brizzo]

FIRST: Apologies to the Mods for having to expurgate my expletive. I was a bit angry when I typed that. I love how supportive, nice and gentle this site is.

My Derm has made a multi year study of mixed connective tissues disorders. He designed and developed a panel of blood tests for Quest Labs for a variety of M.C.T.D. that is still used today. It seems that so much of this can be seen on the skin. Then again, many more systemic disease states appear with cutaneous signs than one would imagine.

One of the SF Bay Area's foremost experts on MCTD is a Derm at Stanford, Dr. Fiorentino. My Derm was a Stanford professor along side him.

I've been working with Dermatologists for the last 22 years. Currently, I work for Novartis and I launched the biologic, Cosentyx. For many years I was in, what we call, "Lotions and Potions". My focus was on the relief and resolution of common skin disorders like acne and steroid responsive dermatosis. Two decades ago we were not focused on the entire system... just the skin. Only the most forward thinking Derms looked beyond the surface. One of my old customer's, Dr. Connant was the first person to identify AIDS through the examination of the skin. With the advent of Biologic treatments, we are focusing more and more on metabolic disorders. We are finding that the skin is the window into the body.

The focus of Biologic treatments is psoriasis and psoriatic arthritis. The deeper we look, the more we find out just what goes hand in hand. The plaques on the skin merely indicate that one's immune system is wildly out of whack. The series of metabolic disorders that are "underneath" the plaques are amazing... Diabetes, high blood pressure, heart disease... so many. In fact, a study was just done to see how the treatment of PSO with biologic also affected negative cardiac outcomes. The results staggered me... Statins are the gold standard for reducing negative cardiac outcomes (NCO's). Subjects on a variety of biologic classes were followed (along with statins as a control) to see what the rate of NCO's were. People treated with TNFa's had a lower incidence of NCO's than statins. People treated with IL-12/23's had a higher incidence of NCO's. People treated with IL17a's had double digit lower NCO's!!!! Sometimes if you treat the skin, you treat the entire body.

I know I ranged far afield here but, the pain aside, I am finding all of this fascinating. For the last five years, I have been observing AI disorders from the outside, looking in. Now I am on the inside, looking out. It has made me a better, more useful and more informed Rep. I may be in a ton of pain right now but I am still finding it fascinating.

[irish]

I have always been interested ion dermatology and enjoyed working on that floor when I was in Nurses training (back in another lifetime)

I started with a dermatopathologist back in the early 2000's and he diagnosed my first autoimmune disease which no one else seemed to deem important. I had been having a skin condition that came every couple of years in the same place on both upper arms and treated with an antibiotic and cortisone cream ...this by my first deem who knew nothing.

When I saw Dr. DP (second deem) I had an arm that was swollen up like a log from shoulder to elbow. It hurt like heck and was red also. Turns out I had a 13 CM bullae on the back of this arm that was draining. I had bacterial and fugal infection and was put on anti B. Anti F. and prednisone tabs. He did a biopsy and it came back positive for Bullous Pemphigoid. I was flabbergasted. I couldn't see the blister on the back of my arm so didn't realize how bad it was.

Anyway, that dermatopathologist knew his diseases both systemic and skin. He told me years later that he always had me pegged for a "lupus" but my blood work always came back negative. Sooo, I get what you have been working with and it must have been interesting. Medicine is interesting.

My autoimmune has been flaring lately(it always flares what am I saying) and I have had a lot of strange skin lesions that have grown and needed to be removed. I was blessed with my first squamous cell lesion on the bridge of my nose and head for a deem surgeon that specializes in Mohs procedure and does lesions that are in difficult places..mine sure is. So, yes, the skin is the biggest organ of the body and sure tells a lot about our health. Thanks for the interesting info you posted. Irish