A few months ago, I described a 52-year-old female patient's puzzling rash to a colleague: a striking symmetrical, bright-red, sharply-defined macular erythema of the genital/inguinal and medial-gluteal areas, and much less prominently, the axillae and inframmary folds. Sitting on her desk was an article, just read, describing this unusual drug eruption. Coined the "baboon syndrome" because of the resemblance to the red buttocks of baboons, it has been renamed the less colorful, less memorable, but less-unnerving-to-be-diagnosed-with "symmetrical drug-related intertriginous and flexural exanthema" (SDRIFE;Hausermann, Harr, & Bircher, 2004).
I said it was good luck that she had just read this article, and a colleague commented, paraphrasing Louis Pasteur, "Chance favors the prepared mind" (L. Pasteur, lecture at the University of Lille, December 1854). If she had not chosen to spend her free time reading dermatology, she would not have been freshly-armed with that diagnosis, so useful to my patient that particular day. "Luck is where preparation meets opportunity," attributed to Seneca, is cited by Snieder and Larner (2009) in The Art of Being a Scientist: A Guide for Graduate Students and their Mentors. They remind us that by making the decision to take advantage of (often fleeting) opportunities, you can "create your own luck" (p. 253), and influence the quality and direction of your work.
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The New England Dermatology Nurse Practitioner Society has its meetings on the evening of the fourth Thursday of each month, featuring a guest lecturer, from whom I invariably learn something that contributes to my practice of dermatology. I admit that sometimes it is easier to head home, skipping the rush-hour traffic and the meeting, assuring myself that I have worked hard enough that week. However, it is the decision to take advantage of these opportunities that allows us to learn more dermatology, as well as about professional opportunities, and in my case, to meet and encourage potential authors and reviewers. At a memorable meeting last winter, during a howling snowstorm one dark Thursday night, I met Susan Busch and Jane Tallent, the 2009-2010 Lahey Clinic Dermatology Nurse Practitioner Fellowship fellows, quintessential examples of individuals who heartily seek out learning opportunities. We talked animatedly about ways they might contribute to the Journal, and I forgot how sweet it would have been to stay home and light a fire in the fireplace.
When an uncanny opportunity presents itself to apply something we have just learned, we can remind ourselves that we helped create this fortunate situation; we helped create our own luck. A dermatology nurse approached me at the 2009 Dermatology Nurses' Association summer meeting in Boston, reporting that only a day or two after she was introduced to Merkel cell carcinoma by the JDNA article by Victoria Garcia-Albea (nee Beebe; Beebe, 2009), she heard colleagues discussing a new patient diagnosed with Merkel cell cancer in their practice. Had she not taken the opportunity to read Victoria's article, her ears would not have perked up when she heard this unusual diagnosis. As it was, not only did she speakup and learn about the patient, but she approached me about writing about the case for the JDNA. She is someone who spots and exploits-and creates-opportunities.
The JDNA has been helpful tome in my practice as a dermatology nurse practitioner. I felt better equipped to answer the questions of a solid organ transplant patient, after reading Victoria Lazareth's(2010a, 2010b) series, "Dermatologic Care of the Transplant Patient," part two of which appears in this issue. I have started to incorporate both the Smack-a-Mole game and "SunAWARE" in patient teaching, and have found "SunAWARE" a handy way to efficiently document counseling in clinic notes (see both articles in this issue) (Fairbrother & Fairbrother, 2010; Barrow, 2010). A number of times I have, with patients as well as colleagues, referred to the recent article by Miriam Kravitz, graduate student in the Doctorate of Nursing Practice Dermatology Residency at the University of South Florida, "Indoor Tanning, Skin Cancer, and Tanorexia: Development of US Indoor Tanning Policy" (Kravitz, 2010).
It has been extremely helpful to be able to pull out the Skin Cancer Foundation's thoughtful, evidence-based rebuttal (see "In The News," in this issue) to recent challenges concerning the safety and effectiveness of sunscreen, the dozens of times my patients-often as an aside, during a skin check-have alluded to these charges (Skin Cancer Foundation, 2010; http://www.skincancer.org/recentattackssunscreen.html).
My patients will also benefit from Ted Scott's patient handout on intertrigo in this issue (Scott, 2010), which offers instructions more specific than I had used in the past. I have already several times shared the detailed handout, "Cosmetic Options for Covering Hair Loss," prepared by the Cicatricial Alopecia Research Foundation (http://www.carfintl.org), and published as part of Sheila Belkin's article in the May-June issue of JDNA (Belkin, 2010).
Every time we take advantage of an opportunity, we are preparing ourselves. We all know that sometimes the investment of time will be disappointing. But any number of disappointments will be greatly offset by that one lecture, that one article that gives us a new insight, introduces us to a person or concept or diagnosis that might make a difference to us-and to a patient, on a particular day, sometime in the future.[black small square]
Barbara B. Starr