'I Had To Fight For A Skin Biopsy'

By Melinda Wenner Moyer, Women's Health

Three women share their stories of what it's like to live in a dermatology desert.

In our September 2017 issue, we published a special report about "dermatology deserts," or areas where it's impossible for women to see a dermatologist in a timely manner—even if they suspect they may have skin cancer or, in some cases, even after they've been diagnosed with melanoma and need to have it removed. But melanoma isn't the only concern. Check out our investigation, then read about some of the other skin issues that this dermatologist shortage affects:
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Forty million Americans suffered from skin infections in 2013, according to a 2017 AAD report—many of which can’t be cured with over-the-counter meds and can become contagious or deadly if not treated quickly. And they’re on the rise: 25 percent more Americans were admitted to hospitals in 2011 versus 2005 for serious bacterial skin infections such as MRSA and necrotizing fasciitis. “The public doesn’t understand the seriousness and the burden that skin diseases have on patients,” says Columbia, Missouri, dermatologist Karen Edison, M.D., the deputy chair of the AAD’s Access to Dermatologic Care Committee. Here are a few common skin issues of concern:

MRSA

What it is: A contagious antibiotic-resistant bacterial skin infection

Symptoms: Usually starts out as swollen, red, painful bumps that look like spider bites, which then cause fever.

Consequences: It can kill in as quickly as one week without careful treatment, typically an IV of an antibiotic to which it is not resistant.

Necrotizing Fasciitis

What it is: A bacterial skin infection that usually enters a cut or scrape, destroys tissue, and spreads quickly

Symptoms: Pain, soreness that feels like a pulled muscle, fever, chills, fatigue; can feel flu-like

Consequences: It can kill in days unless intravenous antibiotics are given. Surgery is sometimes necessary.
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Psoriasis

What it is: An inflammatory skin disease that afflicts 7.5 million Americans

Symptoms: Red, scaly patches that itch or burn

Consequences: People with psoriasis often have widespread inflammation, putting them at risk for stroke and depression. Those with severe versions report low quality of life.

Impetigo

What it is: A highly contagious bacterial skin infection, common in kids and athletes

Symptoms: Pus-filled, itchy sores that break open after a few days and crust over

Consequences: It sometimes clears up on its own, but antibiotics are recommended because severe impetigo can lead to serious kidney disease.

Of course, knowing about these conditions and experiencing them are two different matters. So we connected with three women who had to wait to see a dermatologist, despite experiencing scary skin symptoms.
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“I had to wait to see a derm, and MRSA almost killed me.”

Last year, Anna—who asked to remain anonymous—developed a sore on her lower back and saw her primary-care physician, who thought it might be a fungal infection and wrote her a prescription for a topical cream. By the next weekend, the rash had spread, so Anna went to a local urgent-care clinic. The clinic didn’t have the facilities to run tests, so the doctor gave her a high-priority referral to a dermatologist. “When I called the dermatologist’s office on Monday, they offered me an appointment five weeks out,” she recalls. It was raining the day she called, so Anna demanded that they fit her in if someone canceled—which the receptionist did. It turns out Anna had MRSA, a bacterial infection that can kill within a week. Thankfully, she recovered quickly with the right antibiotic and is no longer contagious—but had she been forced to wait five weeks, the infection could have infected her blood and organs, increasing the chances that she could die.

THE TAKEAWAY: 
Anna knew from her experience at work—she’s a nurse herself—that patients often cancel their doctors’ appointments on rainy days. So if you call today and can’t get a timely appointment, call again on a day it rains, tell them it’s pressing, and ask to be alerted if there’s a cancellation.

“I almost died from my melanoma while I waited—now I’m struggling to get the right care again.”

Three years after her first cancer incidence, Amanda Greene noticed a second dot on her stomach that was growing in size, so she called her dermatologist’s office and asked for an appointment. This time, she was told to wait not two, but three months. “I was like, ‘Um, wait. You know I have a history of melanoma—you’ve got to be kidding me!’” Amanda recalls. The receptionist didn’t change her tune, so Amanda hung up and this time immediately called another derm, who was able to squeeze her in the next week. Her mole, she learned, was pre-melanoma, and the doctor scheduled her for surgery the next day.

THE TAKEAWAY:
If the receptionist isn’t helping you secure an appointment and you’ve explained that your condition is potentially serious, insist on speaking to the doctor or a nurse, who should better understand symptoms that need immediate care. You can also ask your GP to call the derm on your behalf, which may help.
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“I fought for a biopsy, and it was basal cell carcinoma.”

In the summer of 2007, then-26-year-old Arielle Driscoll discovered a tiny dot on her chest that itched and bled when she scratched it. “It just wasn’t right; it wasn’t healing,” recalls Arielle, now 36 and a pediatric sleep consultant in Bolton, Massachusetts. So she went to see her primary-care doctor, who was sure it was nothing to worry about. Still, the doc offered to refer Arielle to a dermatologist, and she agreed. But she couldn’t get an appointment until January. When it finally happened, the dermatologist, too, didn’t think it was cause for concern. Arielle continued to press, so the derm offered to biopsy the mole to quell Arielle’s fears. The mole turned out to be basal cell carcinoma, a slow-growing form of skin cancer, which she then got surgically removed.

THE TAKEAWAY:
Convinced something is wrong and your doctor isn’t taking you seriously? Don’t waver. “What this taught me is that you have to be your own health advocate,” Arielle says.

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