In dermatology, we are fortunate to have many insightful practitioners and great teachers and mentors. Some are bright stars in our special universe–others unsung heroes. All of these colleagues have much to share, from wisdom to humor to insights into dermatology and life. This column allows us to gain insight from these practitioners and learn more about them.
Jashin J. Wu, MD, earned his bachelor degree and medical degree through the combined 7-year Honors Program in Medical Education at Northwestern University. He completed his dermatology residency at the University of California, Irvine, where he served as chief resident. He is the founding director of dermatology research and director of the Psoriasis Clinic in the department of dermatology at Kaiser Permanente Los Angeles Medical Center.
Dr Wu is a medical board member of the National Psoriasis Foundation (NPF) and a councilor for the International Psoriasis Council, serving as co-chair of the biosimilar working group. He serves on the ad hoc psoriasis workgroup of the American Academy of Dermatology and on the Work Group for Guidelines of Care for the Management of Psoriasis for the American Academy of Dermatology and the NPF.
He is coeditor/author for 5 textbooks including Therapy for Severe Psoriasis, 1st ed, 2016; Mild-To-Moderate Psoriasis, 3rd ed, 2014; and Moderate-To-Severe Psoriasis, 4th ed, 2014. He has written more than 200 Pubmed articles, of which more than 100 are about psoriasis. He is immediate past president of the Los Angeles Metropolitan Dermatological Society, a board member of the California Society of Dermatology & Dermatologic Surgery (CalDerm), and a board member of the Pacific Dermatology Association.
Dr Wu enjoys traveling with his wife and has visited more than 40 countries. His main hobby is following professional tennis, and he has attended Wimbledon, the French Open, the Australian Open, and the US Open.
Q. What part of your work gives you the most pleasure?
A. Treating patients who have seen multiple dermatologists to no avail and then successfully treating them myself gives me immense professional satisfaction. I can think of several such patients where I had placed them on a “big gun” medication like cyclosporine, infliximab (Remicade), immunoglobulin therapy, rituximab (Rituxan), etc., to clear up their severe dermatitis, widespread prurigo nodularis, blistering disorder, pyoderma gangrenosum, psoriasis, etc. It is extremely rewarding to see these patients who come to me initially frustrated and then become relieved to be finally cleared of their skin disease. It should be noted that these therapies should not be seen as a “big gun” and dermatologists should be encouraged to prescribe them. These medications can and should be used to treat many tough diseases instead of relying on topical steroids. Those who are afraid of using cyclosporine and other “big guns” may be doing a disservice to patients by focusing too much on the potential side effects.
Another enjoyable part of work is conducting all aspects of research. Clinical trials, retrospective cohort studies using our database, review articles, case reports, and writing books, all tap a different part of the brain and present new challenges that keep me engaged. Research has also given me the opportunity to travel the world to speak about psoriasis. I relish the challenges of complex medical dermatology and research.
Q. Who was your hero/mentor and why?
A. Gerald Weinstein, MD, was my first mentor in psoriasis while I was a resident at the University of California, Irvine. This was the beginning of the biologic age, and he was the first to show me how grateful patients with psoriasis can be when he cleared them with a biologic after suffering with almost whole body psoriasis for years. Dr Weinstein sadly passed away a couple of years ago, but it was my great honor to deliver a lecture at the University of California, Irvine last year in the Weinstein library.
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Q. Which patient had the most effect on your work and why?
A. I can think of an interesting patient that I saw when I first started out as an attending. The patient was a lady in her forties who was a registered nurse who developed whole body dermatitis. Prednisone tapers would control the flare temporarily, but then the dermatitis would flare again. I put her on cyclosporine 5 mg/kg day, which controlled the dermatitis. However, because she was a nurse and had some medical knowledge, she would look up information about cyclosporine, become afraid, and then stop the cyclosporine due to worries of side effects. When she flared again, I would reassure her about the side effects and told her that her labs were normal. After cycling in this fashion for a few visits over 6 months, I realized I had not seen her for a while. About 4 months later, she came back for an unrelated issue. I asked about her dermatitis, which had resolved with no treatment (she had stopped the cyclosporine on her own). Apparently, she had been eating berries from her backyard, which prompted this whole body allergic dermatitis, and after she stopped eating the berries, the dermatitis resolved. While she was incredibly grateful for my managing her severe rash, this taught me that history taking is still important for a dermatologist. I now always ask patients like this if they eat anything unusual from their backyard garden!
Q. What is the best piece of advice you have received and from whom?
A. My parents taught me to “save money for a rainy day,” and my father helped encourage my interest in financial literacy and the stock market when he shared his “lucky” stock picks and his reasoning in selecting these. As physicians, I think it is easy to have tunnel vision focusing only on medicine, but I think it is interesting to see how the financial and business side of medicine can affect patients and our daily lives. I follow the market and financial news daily, which also serves as a break from medicine.
Q. What is the greatest political danger in the field of dermatology?
A. Marginalization of our specialty is the greatest political danger. Other fields may not value what we offer because they might see us a simple “pimple popper” (thanks, Seinfeld…). It is compounded by the fact that the media portrays dermatologists as mostly cosmetic dermatologists. There are many patients out there with severe skin disease that we as experts of the skin should be treating. If future generations of dermatologists continue to focus their careers more and more in cosmetic dermatology, then slowly diseases that we see will be shared and then taken over by rheumatologists and allergists.
Dr Barankin is a dermatologist in Toronto, Ontario, Canada. He is author-editor of 7 books in dermatology and is widely published in the dermatology and humanities literature.