Volume 10
Number 1
Janum'y, 1984
keratoses, one of the commonest premalignancies, we
do have evidence of DNA repair abnormalities.
Rona M. MacKie. M.D.
Clare P. Fitzsimons, M.B., Ch.B.
Deparnnent of Dermatology
Anderson College Bldg.
56 Dumbarton Rd.
Glasgow Gll 6NU, Scotland
REFERENCES
1, Staberg B, Wulf HC, Poulsen T: Carcinogenetic effect of
sequential artificial sunlight and UV-A irradiation in hair-
less mice. Arch Demaatol 119:641-643, 1983.
2. Abo-Darub JM, MacKie R, Pitts JD: DNA repair de-
ficiency in lymphocytes fi'om patients with actinic kerato-
sis. Bull Cancer 65:357-362, 1978.
3. Abo-Darub JM, MacKie R, Pitts JD: DNA repair in cells
from patients with actinic keratosis. J Invest Dermatol 80:
241-244, 1983.
4. Lambert B, Ringborg U, Swanbeck G: Ultraviolet-in-
duced DNA repair synthesis in lympbocytes from patients
with actinic keratosis. J Invest Dermatol 67:594-598,
1976.
D e r m a t o l o g i c v e r s u s p o d i a t r i c c a r e of the foot
To the Editor:
I am writing to respond to the letter by Robert N.
Richards entitled "Dermatologic Manpower and Pa-
tient Availability" (J AM ACAD DERMATOL 9:167,
1983), Dr. Richards wrote to suggest ways in which
dermatologists might increase their patient loads. One
of his suggestions was to take a "greater interest in
plantar corns, calluses, and even plantar warts." He
stated that " m a n y of these problems and related foot
problems are now attended by podiatrists, who gen-
erally do not handle them as well as a dermatologist
who has an interest in this area."
I object to the notion that the common keratotic dis-
orders and warts of the foot would be better handled by
"interested" dermatologists than by podiatrists, To
dispense with warts, I have spoken with dozens of der-
matologists and podiatrists alike about their success
with plantar warts and, dinitrochlorobenzene (DNCB)
and bleomycin notwithstanding, they are a crap shoot at
best. Most corns and calluses are not primary cutaneous
problems but are usually secondary to the bone and
joint maifestations of lower ex~emity pathomechanics
and/or arthritic deformities. If the primary deformities
are not addressed, either palliatively or surgically, the
lesions will invariably return. Both a den-natologist and
a podiatrist can ably debride and pad a corn on the
Correspondence 119
proximal interphalangeal joint of the fifth toe. How-
ever, the dermatologist is not likely to be prepared to
correct the problem with an arthoplasty while the
podiatrist is. Given a patient who wants a correction
(assuming good vascular status, etc.), is he not going to
be better served by the practitioner who can handle the
problem either way? The Journal recently presented
this issue in a collaboration by one of you and one
of Us. t
I do not doubt that an "interested" dermatologist
could do an excellent job of treating these conditions,
but if so, it is done by first learning what we do. I
understand that one of the most well-attended forums of
the annual meeting of the Academy is on treatments of
nail disorders. Probably the best way to cure an in-
grown nail is the chemical "matrixectomy" using phe-
nol (topical), which was presented at a recent forum.
The technic was developed by a podiatrist.
As a side issue, I have referred quite a few patients
to dermatologists by noting skin problems elsewhere on
the body which may or may not have had a relationship
to the problems which brought the patient into the
office. If you want to increase your practice, get to
know a podiatrist. Most likely he will teach you some
"tricks" as well as refer patients to you. Do not com-
pete with the podiatrist, take him to lunch.
Martin Port, D.P.M.
2210 South MacDilt Ave.
Tampa, FL 33629
REFERENCE
1. Gibbs RC, Boxer MC: Abnormal biomechanics of feet
and their cause of hyperkeratoses. J AM ACADDERMATOI_
6:1061-t069, 1982.
To the Editor:
I have been asked to comment on the suggestion,
made by Robert N. Richards (J AM ACAD DERMATOL
9:167, 1983) that delanatologists should take "a greater
interest in plantar corns, calluses, and even plantar
warts" in order to increase their practices. Dr. Richards
stated further that "many of these problems and related
foot problems are now attended by podiatrists, who
generally do not handle them as well as a dermatologist
who has an interest in this area." A subsequent reply to
the JOURNAL by a highly qualified podiatrist, Dr. Mar-
tin Port, refutes Dr. Richards' claim.
It is clear to me that after attending scores of podiat-
ric lectures and seminars and faithfully reading a few of
their journals that the average practicing dermatologist