Pimples that Kill.

There is an area of the face known as the dangerous area of the face. This area is can be found by drawing a triangle with one tip between your eyebrows and have the base of the triangle at your upper lip. Here is a picture. The venous drainage of this area of the face also drains parts of the brain. This area is called the dangerous area of the face because there are documented cases of large pimples managing to infect systemically and cause death. I don't think that has happened much since the advent of antibiotics, but the dangerous area of the face received it's name in the 1850s not the 1950s. I'm really not kidding about this. A paper was published in 1852 that documented six cases of patients who had pimples in the dangerous area of the face and died (I couldn't get a copy of the original paper, so I have referenced a paper from 1932 that discusses the 1852 paper). Really it's true. So anyway, the first patient was a 20 year old otherwise healthy male who had a pimple near his upper lip. He scratched off the head of the pimple six days before his admission to the hospital and died 36 hours later. See there was a reason your mother told you not to pop your zits--it has killed people!

I'm giving you all of this background information so that I can tell you a funny story. I really should have blogged about this story last spring when it occurred, but I guess I didn't find it as funny at the time. Anyway, at the end of my second year of medical school, I had a clinical medicine lab every Thursday morning. There were eight students, one professional patient and one professor. I loved my professor. Let's just call him Dr. MD/JD. Dr. MD/JD was in his 70s. He was from the Caribbean and did his residency at the University of Edinburgh in surgery (and is board certified in surgery in the U.K.). He came back to the Caribbean and worked as a surgeon for a number of years and then at some point decided to move to the United States. If you are a physician from another country you must pass all of the U.S. medical boards and then repeat your residency to practice medicine in the U.S. Thus, Dr. MD/JD decided to do his U.S. residency in Family Medicine and is still board certified to practice here. While he was in the U.S., he got into a debate with a law professor about the difficulty of law school and the law professor challenged Dr. MD/JD to go to law school at night if he thought law school was really that easy. Well, apparently law school was that easy for Dr. MD/JD because he not only earned his Juris Doctorate he passed the bar and is still a partner of a law firm in the U.S. Not only did Dr. MD/JD have an extremely broad range of knowledge, he was really funny and I think he honestly cared about his students. Dr. MD/JD even picked up prescriptions for one of my friends because the only pharmacy in the country that carried the medicine my friend needed was in the capital (over an hour drive from school).

One lab session, Dr. MD/JD walks into class and jets right toward one of the girls in the class, who we will call Blemish. Blemish had a pimple the size of Mt. Everest in the dangerous area of the face. Dr. MD/JD asked if Blemish knew she had a pimple. Blemish was quickly turning as red as her pimple as she informed Dr. MD/JD that she had noticed it. In fact, it was pretty obvious that she tried to cover up Mt. Everest, but Mt. Everest was so large that no amount of make up could cover it up. Dr. MD/JD then started asking her when it first arrived, what she was doing to treat it, and warned her not to pop it or she could get a systemic infection. Then he told her if it wasn't gone soon, she need to have it drained by a physician. Blemish was thrilled when Dr. MD/JD decided it was time to start the lab; however, he did take this opportunity to review infections, antibiotics and why the dangerous area of the face is so darn dangerous.

The next week, Blemish walked into class just as we were starting. As Blemish walked into class, Dr. MD/JD said he was so happy she made it because he was getting worried that the pimple had gotten out of control. The he went right over to her to check on Mt. Everest, which was almost gone. He said that he had been worried about her all last week. That pimple that could kill.