Of skin and wit: Derm has passion for medicine, writing and comedy

At 86, Jerome Z Litt, M.D., is in full-time dermatology practice; is the sole author of the popular Drug Eruption Reference Manual (in its 14^th edition, and he has written every one); and has the comedic timing and voice of actor-comedian Mel Brooks.

Many of Dr. Litt's 107,000 patients would recognize his humor. He coined the term "cell phone acne," claiming it is the "zits, goobers, zingers, honkers, screamers and splashers on your cheek where you hold the phone." Dermatologists refer to his manual on a regular basis. And many consumers have come to know him as an authority on skin, as author of Your Skin from A to Z.

Dr. Litt says his 56 years in dermatology practice came to a glorious head earlier this year when he was made an honorary member of the American Academy of Dermatology, in recognition of his contributions to the field.

The happy detective

The assistant professor of dermatology at Case Western Reserve University School of Medicine says dermatology appealed to him during his internship at Kings County Hospital, Brooklyn, N.Y., because dermatologists seemed a happy lot and would come to work looking refreshed.

"It was also a big detective story, trying to find a reason for a certain eruption, doing surgical procedures. .... It was a specialty for all seasons. You could be a detective. You could cut things out to see what they were. You could make people feel better, happier and less itchy. For the most part, you could make people look prettier," Dr. Litt says.

Making his patients happy keeps him wanting to practice some two decades after most people retire, he says.

Endless learning

Dr. Litt works on updating his Drug Eruption Reference Manual two to three hours a day. The work, he says, makes him a better detective - one who can usually find out why people develop rashes, itching and eczema.

Of the many drugs that stand out as being a rash culprit are those with sulfa, including ophthalmic drops (oral and eye), as well as acne, oral anti-diabetic and high blood pressure drugs.

"A lot of toothpaste brands and soft drinks contain it, as do drugs for benign prostatic hyperplasia," he says. "I want to acquaint my dermatologic partners that if they find a patient who has a rash, which they think might be sulfa-related, they should also go back and find out in the history some of the other nondermatologic medications that the patient is taking."

Genetic humor

Dr. Litt says his humor comes from his family. While growing up in New York City, he would write and perform in local comedies and other stage productions.

"I was a wag (a humorous person) when I was younger. Like Lenny Bruce, I came from Brooklyn. I wasn't quite as scatological as Lenny Bruce, but I grew up with his humor and was sort of a comedian, myself," he says.

Always listen; always ask

In nearly six decades of practice, Dr. Litt says his take-home message is simple: Listen to what patients have to say. Taking a good patient history is one of the most important things a dermatologist can do to determine the cause for eruptions.

"You have to ask: 'What have you taken in the past 36 hours, before the rash broke out?'" he says.

Dr. Litt tells his patients to call the office after they leave, just in case they think of anything else they might have done differently before the eruption broke out.

Always the eruption detective, Dr. Litt says he was the first to break news that the fabric softener Bounce (Procter & Gamble) triggered rashes in some who used it.

"I found 17 different people who had rashes from Bounce, and (I) wrote an article, but two journals rejected it," he says. "Several months later, I got an apology from one journal saying that they realized that Bounce was one of the culprits of rashes."

Writing consumer books is Dr. Litt's way of setting the records straight about skin myths and misconceptions. He writes about how poison ivy dermatitis is not contagious; hair shaved from people's legs does not grow back longer, thicker, darker and faster than hair that has not been shaved; ringworm is not caused by a worm; shingles is not due to "nerves"; and cellulite is just plain fat (and you cannot get rid of it.)

Dr. Litt has written three versions of his book, Your Skin from A to Z, with the last being published in 2002. He does it, he says, not to make money but rather to educate.

No signs of slowing

Dr. Litt shows no signs of slowing. He is busy seeing his 107,000 patients (although, he points out, not all on the same day) and writing the 15th edition of the eruptions manual. He works, he says, because he likes to eat, and his wife "makes a mean pasta."