Evidence of Learning Assessment #2 (Primary)

Type of Assessment: ​Mentor Visit

Mentor: ​Dr. Jennifer Dharamsi

Profession: ​Dermatologist

Location and Business Name: ​Legacy Dermatology

Date of Visit:​ January 22, 2018

Time:​ 8:20 A.M - 2:10 P.M.

Analysis:

The second mentor visit was amazing! I shadowed Dr. Dharamsi and leaned even more

from her. During this visit, unlike the first one, the patients we saw, were there because of scalp,

nails and eczema. It was very interesting to listen to the patients and find out what was wrong

with them and help them get medicine that would give them the best results.

During this visit, I learned about body checks and why they are done on the patient. Dr.

Dharamsi likes to do a full body skin check on all of her new patients to make sure all of her

patients have health skin and on her patients yearly. The main purpose of a screen screening/

skin exam is to look for cancer before a person has any symptoms. This can help find cancer at

an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the

time symptoms appear, cancer may have begun to spread. Dr. Dharamsi begins the check on

the front of the patient’s body. First she looked at the patient’s arms thoroughly, then to their

shins. Then she makes her way to their calves, after that, she looks in the person’s underwear

to see if there is anything on their buttocks, then she works her way up to their back. While
looking at the patient’s back, she uses this tool known as a dermascope. A dermascope is a

handheld device that uses polarized light to magnify an area ten times. The features of a brown

spot become more prominent and the pattern of pigment can be seen clearly (lesions may look

gray, blue, red, or black under the dermatoscope). Most important, dermoscopy helps evaluate

the depth of pigment. Most lesions that might be (or become) melanomas are almost always

surgically removed for biopsy. But this strategy can prove problematic if there are multiple

atypical lesions. She spends a great deal of time looking at the patients back with the

dermascope to observe moles and or “sunspots”. Before she finishes the check, she inspects

the trunk (anatomical term for the central part of the body from which extend the neck and

limbs). She finishes the check by, looking through the patient’s scalp to inspect for moles or

anything else harmful.

My time being at the office, there were a number of patients with seborrheic dermatitis.

Seborrheic Dermatitis is considered a chronic form of eczema. Seborrheic Dermatitis appears

on the body where there is an abundance of oil-producing (sebaceous) glands like the upper

back, nose and scalp. Seborrheic Dermatitis is also known as ​seborrhea. ​Seborrheic Dermatitis

affects infants, adolescents and adults. There are more than 3 million cases of Seborrheic

Dermatitis in the United States. Men are more commonly affected by SD. Since Seborrheic

Dermatitis is a type of eczema, there is not an exact cause for this skin disorder. Hormones and

genes play a role in this skin disorder. Microorganisms such as yeast, that live on the skin

naturally can also contribute to seborrheic dermatitis. It also can be triggered by, the change in

the weather (humidity and seasons), trauma (ee, scratching) or emotional stress. The patients

that came in for seborrheic dermatitis, noticed that the cold and dry weather caused them to

have awful flare ups.

 While doing the body checks, Dr. Dharamsi, identified some of the spots on the patient’s

body as ​sunspots. ​Sunspots are also known as ​Actinic keratosis/solar keratosis. Actinic

keratosis forms when the skin is badly damaged by ultraviolet (UV) rays from the sun or indoor

tanning. Most people get more than one AK. When you have more than one AK, you have

actinic keratoses, or AKs.These typically occur on the face, lips, ears, bald scalp, shoulders,

neck and back of the hands and forearms. Ranging in size from a tiny spot to as much as an

inch in diameter, AKs usually appear as small crusty or scaly bumps or “horns.” The base can

be dark or light skin-colored and may have additional colors such as tan, pink and red. People

with fair skin, normally develop AKs more. AKs are found on men more than women, because

men tend to have more outdoor activities than women. If AKs are left untreated, they may turn

into squamous cell carcinoma, which is a type of skin cancer.

Lastly, I learned about onychomycosis. This condition is a fungal infection of the toenails

or fingernails that can involve any component of the nail unit, including the matrix, bed, and

plate. The patient with this condition, their nail was not connected to their nail bed and it looked

like it could be yanked off. It is a very interesting condition. To try and help the nail grow

properly, Dr. Dharamsi, gave the affected nail injections to help the process and to kill the fungal

infection. This is a topic I would like to do more research over and find out how to help people

with this condition.

This was a day for hair, nails, and seborrheic dermatitis and I found it very interesting

and informative. As I spend more time with Dr. Dharamsi, the more I want to be like her. With

some of the patients, they felt discouraged because the other dermatologists they had seen,

gave up on them because of they did not know how to help them due to their conditions.

However, she take time to go through what would be wrong with the patient and how to help
them. She also takes the time to explain their conditions to them and she explains it to me more

depth so I can learn.