EP 55: Derm Confessions — The Weirdest Things We've Seen in Practice — Part 1

Every dermatologist has stories they can't tell at dinner. This is that episode. Dr. Dustin Portela and Austin Lee set aside the science and spend an episode doing something different: sharing the cases that stuck with them, the moments they didn't see coming, and a few things patients put on their skin that genuinely defy explanation. No personally identifying details. No punching down. Just two clinicians who have spent a combined two decades in exam rooms and have earned the right to say what practicing dermatology actually looks like. The misdiagnosis stories alone are worth the listen. Both hosts independently encountered the same scenario early in their careers: a nail condition that had been treated as fungus for months, or years, that turned out to be melanoma. One patient lost a toe. One lost a thumb. The cases are told plainly, without dramatizing them, which somehow makes them land harder. There are lighter moments too. Dr. Portela traces his first memorable experience with skin treatments gone wrong back to his own childhood, when his father, a chemistry teacher, decided that hydrochloric acid was a reasonable approach to a wart and discovered the hard way that paper cups are not chemically resistant. Austin's most memorable patient story involves a rosacea treatment approach that her husband appears to have personally recommended, involving a substance with no clinical evidence and a texture that defied description. It is presented with as much professionalism as the situation allows. Alongside the confessions is a did-you-know segment on Daniel Carrion, the Peruvian medical student who hypothesized that Oroya fever and a common skin condition called verruga peruana were caused by the same bacterium, then injected himself with infected blood to prove it. He was right. He died 39 days later. The disease now bears his name. The episode closes on something quieter: a story from COVID lockdowns about an elderly patient in an assisted living facility who broke down during a routine skin check. It was the first time another person had touched her in nearly a year. * * * **Product of the Week** EltaMD UV Clear SPF 46 The top-selling sunscreen in Dr. Portela's office, now available at shop.drdustinportela.com. A lightweight, niacinamide-based formula that works for acne-prone and sensitive skin. * * * **Follow Us** **Dr. Dustin Portela** TikTok | Instagram | YouTube (Reactions) | YouTube (Educational) | Pinterest **Austin Lee, PA-C** Instagram: @austinleepac **Skinfluence Podcast** Instagram: @skinfluence\_pod