Brandon Litzner

In 2017, Glazer and colleagues published a study revealing significant variations in the dermatologist density across the United States. Specifically, they determined that 38.6% of dermatologists practice in the 100 most densely populated counties and only 1.8% practice in the 100 least densely populated counties. The recommended dermatologist density suggested by the American Academy of Dermatology is 4 dermatologists per 100,000 population.

Rural dermatology is not as simple as it seems. For some, it means being the only dermatologist in a county where patients drive 3 hours for an appointment; for others, it means practicing in a mid-sized town and serving as both community doctor and regional referral point. Too often, rural dermatology is dismissed as isolating or career limiting, but the truth is very different.

The skin biopsy revealed a nodular collection of foam cells (quiz image [bottom]). Tuberous xanthoma was the most likely diagnosis based on the patient’s history as well as the clinical and histologic findings. Tuberous xanthomas are flat or elevated nodules in the dermis and subcutaneous tissue, commonly occurring on the skin over the joints.1 Smaller nodules and papules often are referred to as tuberoeruptive xanthomas and exist on a continuum with the larger tuberous xanthomas.