Haven’t we all felt it?
From the Editor
Dr. Schwarzenberger is the former physician editor of DermWorld.
By Kathryn Schwarzenberger, MD, FAAD, September 1, 2023
Imposter syndrome. Those pervasive feelings of inadequacy that sneak up on you, convincing you somehow that everyone in the room is better than you. Surely, they made a mistake when they let you into medical school, selected you for residency, invited you to speak at this conference…Hopefully you are in the lucky minority of physicians who have not experienced at least some of these thoughts, but studies show that imposter syndrome, or at least feelings of inadequacy, are common among medical professionals, starting in our training years. I guess it should not be surprising that this happens in a profession as stressful as ours, where the competition to get in is stiff and performance expectations, both internal and external, start and remain high. Unfortunately, imposter syndrome is emotionally exhausting and can contribute to burnout. Fortunately, there are strategies available to help mitigate it, which contributing writer Andrea Niermeier explores in this month’s beautifully written cover article. It is important to be aware of this phenomenon so we can recognize it hopefully before it has an impact on ourselves and those around us, particularly our younger residents and colleagues.
Contact dermatitis is a subject I actually do know something about! Allergic reactions to cosmetic products are all too common and it can be a challenge pinpointing the offending allergen. In our feature article “Cosmetic conundrums,” Assistant Editor Emily Margosian shares insights from some of our contact dermatitis gurus about new and evolving trends in cosmetic-related contact allergies. Ingredients in products change over time, driven in part by consumer preferences, and likely also by innovation and market forces. As such, our patients today are being exposed to different allergens than they may have been in the past. When I first started patch testing several decades ago, I frequently diagnosed formaldehyde allergies; today, reactions to isothiazolinones are far more common. Alkyl glucosides, such as lauryl glucoside and decyl glucoside, are plant-derived surfactants often found in products hailed as “natural” or “eco-friendly;” unfortunately, as exposures have increased, so have the allergic reactions. Our testing for fragrance allergies has been enhanced by the addition of hydroperoxides of linalool and limonene to our testing batteries; these fragrant terpenes are found in many naturally fragrant products and serve, as I like to tell patients, as building blocks of many essential oils. Patch testing with these allergens has helped us identify individuals with fragrance allergies who might not be detected with our standard mixes. I was amused to learn that another group of people is very learned about fragrant terpenes — the marijuana industry. Turns out those same fragrant terpenes that make lavender and lemons smell so good also give cannabis cultivars their characteristic fragrances. I mention this only to warn you that should you decide to use the internet to learn more about linalool (which, of course, I did) be careful before you click on that website…your institution may not be amused to find you surfing green webpages at work. 😊
I offer a special shoutout this month to my esteemed New Orleans colleague, Dr. Mary Lupo. Anyone who knows Mary knows she is tough, but reading about what it took to rebuild her practice after Hurricane Katrina destroyed the city gave me new respect for what it takes to survive such a disaster. We have talked about disaster preparation before in DermWorld, but Mary offers insights that anyone running a business should consider. You may not live on the coast, but there are steps all of us should think about to protect our practices. With any luck, you will never need them.
