Dear Children,

You adorable little tykes sure don't hold things back the way we grownups do (sometimes). If you think it, you say it.

That's why I'm so grateful to you for asking your Mom, "What are those ugly brown spots on your hands?" Or telling Dad to stop scratching and making fun of him for being so pale. Or letting Grandma know how much you hate those hanging things on her neck.

Your teacher, Ms. Beecher, has been on medical leave for a month. She sits at her mirror and picks at her acne just thinking about what you'd say if you saw her.

George Washington said that honesty is the best policy. Your honesty really works for me.

Thanks!

Dear Infant,

Besides the producers of Teletubbies, no one gives you the credit you deserve for noticing things.

I appreciate you, though. Like when your Mom comes in to have me remove a mole on her chest because you grab at it while you're nursing. Or when you're a little older and point to some mark and yell, "Boo boo!"

You hate bumps, you little devil, don't you? They violate your cute baby sense of order and regularity. When you grow up, you and your health insurer will have fun arguing the exact meaning of "cosmetic" and listing reasons that make it OK for you to get rid of the bumps you've been pointing and grabbing at forever.

Send me those boo-boos!

Goo.

Dear Manicurist/Pedicurist,

I don't know how to thank you for your ongoing project of calling everything you see a fungus. People think that anyway—it really grosses them out—but hearing your expert opinion clinches things. Plus, when you jab at their cuticles, they worry that you're not just diagnosing disease, but causing it.

Of course, I sometimes have trouble talking them out of demanding fungus pills that won't help, but at least they come to the office.

Remember—every nail discoloration or irregularity is a fungus. But you knew that.

Ciao.

Dear Internet,

Web, you really rock!

It used to be that self-diagnosers had to go to a bookstore or library and lug home heavy symptom books, risking back strain or hernia. Now a few mouse clicks in the comfort of their own den, and there's no disease on Earth they can't learn about, see pictures of, and share neuroses and therapeutic advice with sufferers from.

A spot on the groin? Herpes! Fever and a rash? AIDS! Dry lips? Chapstick addiction! A sore belly? Kala-azar! Without you, patients would never even hear about a 10th of the things they now worry about in encyclopedic detail.

Talking them out of these diagnoses and therapies can be tricky. Yet who can argue with the merits of Jeri-Gel for striae and Sculpt-a-Butt for cellulite, with their unconditional, money-back guarantees? Or with green tea compresses and decoctions for everything from asthma to wrinkles to periodontal disease? Or with a 30-page chat-room string on Grover's disease, touting everything from prednisone to Solaraze?

So whether you're academic and ponderous, lay oriented and flip, or just the cyberequivalent of a nosy neighbor, thanks for your support!

Dear Mammography Technician,

I don't know whether seborrheic keratoses really do cast shadows on mammograms, but your concern over them in the mammography field sure generates a lot of referrals. Women are anxious about their breasts anyway, so telling them, "You'd better get that off!" is a great help.

Thanks.

Dear Camera,

Whoever asked for the power to see ourselves as others see us must have had you in mind. Seeing your mug in a photo, or even worse, on camera, has an effect similar to hearing your voice on a tape recording—an acute wish to hide under a rock. With pictures, however, the discomfort is more specific: "Good grief—how long have I had that thing on my cheek?!"

Thanks for the referrals.

Dear Physician,

I sometimes write you in my capacity of consulting colleague, even though the tenor of your referral is often on the order of, "Madge at the front desk has the names of a coupla skin guys. Whyncha pick one?"

At other times, though, the patient comes not because you sent her, but because you walked into the exam room and exclaimed, "WHAT THE DICKENS IS THAT??!!" I've heard too many such tales to dismiss them as poor reporting.

There seems to be something about skin disease that induces exclamations of visceral alarm that go beyond mere perplexity. Other diseases may be pretty inscrutable, yet I can't imagine a doctor looking at a lab report and crying, "Omigosh—your kidneys are a wreck! Check with Madge—she has a list of nephro guys."

Although it might be more professional if you deleted those expletives, I do appreciate your sending folks over.

Sincere thanks to all of you,

A. Derm, M.D.

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