So tell me, how did you get into podcasting? What did that look like from your end?

I had the great good fortune of training my talented co-host, Luke Johnson.

So Luke had a career before he came to dermatology.

He's more interesting than many average dermatologists.

I think everybody's interesting in their own way.

But can many dermatology residents, fellows, and faculty members say they have co-starred in a movie with Mandy Moore? No, they cannot.

Because Dr. Johnson can, yes.

And if

What clues, what telltale signs in the pathologist report should I be looking for? Or if it's not there, should I ask?

You know, you definitely want to see that they're discussing the character of the inflammatory infiltrate.

And if you've biopsied appropriately at the advancing edge of the lesion of PG, where you can really tell it's involved with the inflammatory process, you should have good confidence that they're looking at the right thing.

If you're not hearing the phrase, you know, numerous neutrophils with karyorectic debris, And you also want to see that there had been some kind of special stain performed to at least rule out deep fungal infection and mycobacterial infection.

Tissue gram stains are sometimes a variable benefit depending on the lab, but the infectious stains can be very helpful also in providing certainty that you are excluding the infectious entities that can mimic PG.

i think that having the through line that you have neutrophils actively inflaming the dermal epidermal junction that is a really nice thing to see in a report when i see that as a dermatopathologist it gives me greater confidence to be more strongly worded in my comment but you of course always want to leave a little bit of wiggle room for something that is as nebulous as a leg ulcer think that it's also helpful to have more information from the clinician now there is sometimes a school of thought when you're submitting tissue for something that is a little bit clinically confounded where you don't want to bias the pathologist and i completely understand that concern however you do need to let people know what entities are being considered i think it's a very important thing to include complete clinical information including any comorbidities that might be present for a patient who had developed PG like inflammatory bowel disease, inflammatory arthritis, if the patient has an IgA gammopathy or myelodysplastic syndrome or some kind of hematologic malignancy or a solid organ malignancy.

All of these things would be beneficial history for the dermatopathologist to know, as well as any other entities that you have any suspicion for.

But within that, how do you approach this?

And do you want to take one of those and I'll take the other Michelle?

Sure.

I think that sounds like a lot of fun.

So when we're talking about the auto allergic one, we're talking about a person who's reacting to self allergen, the way that I react to ragweed pollen.

So I hate ragweed.

I wish God hadn't created it.

It's horrible.

Michelle, any final words on CSU that you'd like to leave us with?