My most memorable patient was a 14-year-old girl with Darier’s disease. She was covered from head to toe in thick scales. Her skin was rough and ashy, and she would literally leave a trail behind her when she walked. She was incredibly introverted, shy, avoided eye contact and resisted conversation. 

The patient lived with her grandparents out in the country and had seen a small town dermatologist for years. She spent so much time slathering her skin in topical steroids, over the counter emollients and taking numerous different drugs. Nothing had worked.  Her grandmother told me she had started resisting going to school and that kids had started to really make fun of her. 

We decided to try a round of isotretinoin as an off-label treatment. The patient was incredibly hesitant to try something new and wary about the blood draws required, but after some reassurance, she decided to go for it.  Within four weeks her skin started to clear. 

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The next month, when she returned, you could see a faint smile when we asked her how she was doing. As the months went on, her skin cleared incredibly, and her self-confidence and overall attitude improved. She talked to me openly about school, and her other hobbies. It was the most incredible transformation I have seen in a young patient. 

By the end of her fifth month, we saw almost a complete clearing of her condition. She was able to maintain her skin with over the counter products and occasional topical steroid use for flares. At her last appointment she made a point to look us in the eye, thank us, and give us a hug on her way out of the office. I have not had as much success with this drug and Darier’s as I did with this young patient.I feel so lucky that she responded the way that she did, because I truly believe she needed it more than anyone.