Milan Anadkat, MD, is dermatologist whose areas of specialty include chemotherapy-induced skin reactions, dermatologic therapeutics, collagen vascular disease, autoimmune bullous disease, graft-versus-host disease and psoriasis.
Dr. Anadkat see patients at the Center for Advanced Medicine, Dermatology Center, 4921 Parkview Place, 5th floor, Suite B.
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What happened in the course of schooling to influence you to choose your specialty?
It was not until my last year of medical school that I decided on dermatology -- I truly was open to various specialties. Dermatology was a good blend of both internal medicine and surgery.
I enjoy the rapid diagnosis and reliance on the physical exam, rather than an over-dependence on blood work and lab results. You see the disease and almost immediately either know or don’t know what it is. I really liked the ability to trust my eyes.
In addition, the field is fairly under-represented in medical education. Most non-dermatology physicians will admit they do not know a lot about dermatology. As a result, the specialty is often left for the experts, because most non-dermatologists don’t feel comfortable with dermatology. The opportunity to pursue a field where I could truly be an expert definitely interested me.
Is it a rapidly growing field?
It’s an extremely popular and competitive field for medical students to pursue. There are many opportunities for research because much is not understood at this time. Also, it’s a great lifestyle specialty because overnight or emergency weekend obligations are rare.
Despite the high demand, the field is not growing exponentially, because there are still a fixed number of approved residencies nation-wide. The average wait time to see a dermatologist nationally is typically well over 1 month. Therefore, there is great importance in providing community education to primary care physicians. We want all doctors to know what lesions, rashes, or spots that should concern them.
What brought you to Washington University?
I went to school in northeast Ohio and came to Washington University for my internship in internal medicine. I stayed to pursue a two-year research fellowship investigating up-and-coming dermatology drugs with my mentor, Michael Heffernan, MD.
I continued at Washington University with my residency in dermatology and eventually stayed on as faculty. My initial intent was to be here for a one-year internship and move on, but I stayed after each successive step -- and now I’ve been here for more than a decade.
This is an outstanding dermatology program, and our chief, Lynn Cornelius, MD, is what separates us from other programs. She is a great mentor and is responsible for providing me with an amazing environment where doctors can grow and learn.
Which aspect of your practice is most interesting?
Most of my practice is focused on complex medical dermatology – which includes taking care of patients who have complex skin disease or underlying systemic conditions that manifest with skin disease. As a result, I receive many consultation requests from other physicians who encounter complex skin disease in their patients. I enjoy working closely with the other specialists -- it is both fascinating and humbling to advise these extremely intelligent doctors.
What are some examples of complex skin disease?
Right now, my major research focus is how to categorize and manage the skin reactions patients develop as a result of systemic chemotherapy. Unlike with skin reactions to other drugs, where the recommendation could be to just stop the drug, the challenge here is how to help these patients stay on the cancer fighting drug that may be saving their lives and yet at the same time tackle the skin toxicity of that same drug.
How do you manage the skin reactions from chemotherapy?
There are many different types of chemotherapy (both old and new) that may cause a skin reaction – it’s simply toxicity. The hope is that the patient is able to live with this adverse side effect so he or she can continue the cancer treatment.
With certain types of chemotherapy, especially the newer targeted agents, skin toxicity is actually a good prognostic sign for the patient in terms of his or her battle against cancer. You don’t want to switch the patient to a different drug, because the skin reaction often means the drug is working.
Because there is more at play than just skin toxicity, I leave all the chemotherapy decisions to the oncologists. Dermatology is really just one piece of the pie to help determine if the skin reaction is related to the cancer treatment, if it is life threatening and can be managed. We advise the oncologists so they can make the best decision for the patient.
What skin reactions are a result of chemotherapy?
It’s usually a rash. It can be in a cosmetically sensitive area, such as the face. Sometimes the rash hurts or itches, sometimes it doesn’t, but it’s unsightly. Traditional skin toxicity from cytotoxic agents may include sores in the mouth, redness on hands and feet, hair loss, or nail loss.
Now that chemotherapy treatment is more specific, it targets precise proteins and pathways. A patient might be on four different chemotherapy agents, but usually only one of them is responsible for the skin toxicity. Sorting out which of these agents might be the culprit is extremely helpful to the oncologist. The physician can’t discontinue life-saving chemotherapy by stopping all four agents, so the knowledge of which agent to halt allows the patient to continue the course of treatment with little disruption.
Are you seeing younger patients with skin cancer?
Skin cancer occurs as a result of cumulative sun damage, and is still most common in older patients. Adding up the years of skin exposure, the older you are, the more potential sun exposure you’ve had in your life.
We do see skin cancers in patients who are in their early 20s or 30s, and definitely in patients with lighter skin and those who get more ultraviolet radiation than they should – whether from tanning booths or natural sun exposure. Genetics also play a role, in addition to these environmental exposures, in terms of how likely someone will develop skin cancer. Prevention is dependent on how diligent a person is when it comes to sun protection.
Where are you from?
I was born and raised in Columbus, Ohio. I’ve lived my entire life in the Midwest – first Ohio, and now St. Louis.
Is there a particular award or achievement that is most gratifying?
The award I’m most proud of is the Teacher of the Year Award received from the dermatology residents my first year as faculty here. It was always a goal of mine, that if I stayed on as faculty, I would not only pursue professional interests, but give back to the residents. Early in my career I decided if I was no longer a good teacher to the residents, it would be a sign to move on. The fact that I received that award my first year was very appreciated.
What is the best advice you’ve received?
One of the best pieces of advice I received from my dermatology mentor, Robert Brodell, MD, was to “know what you don’t know”. In an institution like Washington University, where there is no shortage of bright minds and extremely intelligent people, it’s very difficult for physicians to admit they might need help treating a patient.
There is a potential for mistakes to be made when doctors try to do things out of their comfort zone. If we stay in our area of expertise, it’s better for everyone. This is advice I now give to residents
If you weren’t a doctor, what would you like to be doing?
There is a long history of medicine in my family -- my grandfather, uncle and wife are all physicians. I’ve always been attracted to medicine, so it’s definitely something in my DNA. Assuming I didn’t have to work, if I wasn’t a physician, I would be very excited to just spend more time as a husband and a father.
In terms of other career paths, I don’t think there is a clear second love that I suppressed to become a physician. I was accepted into a combined college/ medical school program out of high school – it’s just something I always knew I wanted to do.