Dermatologist's patient's ears and lips 'turned purple'

A PATIENT of a dermatologist who is facing more than 120 allegations of professional misconduct or poor professional performance told a fitness-to-practise inquiry yesterday how his lips and ear tips turned purple after taking a drug prescribed by the consultant.

Patient J (53) from Co Tipperary was treated by Dr Adam Jacobus Smith (65) of the Whitfield Clinic, Waterford, in May 2009. He had attended with an acute rash on his body, was examined and shown photographs of skin conditions and asked if they were similar to his.

He was diagnosed with dermatitis herpetiformis, an autoimmune disease, and prescribed Dapsone. Patient J told the Medical Council inquiry he could not recall whether Dr Smith told him about any side-effects of the drug. He said that on June 8th, his son “took a fit of laughing at the breakfast table”.

“My ear tips had turned purple and my lips were purple through and through,” he said. He went to his GP, who referred him to hospital, where he was given oxygen and admitted immediately. “It was very dramatic,” he said.

He was diagnosed with the blood condition methaemoglobinaemia, an adverse reaction to Dapsone. He was subsequently referred for treatment of his skin condition to consultant dermatologist Dr Colin Buckley, who told the inquiry he believed Patient J never had dermatitis herpetiformis.

Dr Buckley said the dosage of Dapsone prescribed to the patient was too high as a starting dose because of its potential effect on bone marrow.

Among 17 allegations about his treatment of Patient J, Dr Smith was criticised for failing to take a biopsy to diagnose the patient’s skin condition, failing to arrange for pre-treatment blood tests and placing the health and safety of Patient J at risk.

The 123 allegations against Dr Smith in relation to the treatment of 12 patients between March 2006 and May 2009 arose following complaints made by doctors in the Munster Dermatology Group, a group of dermatologists which reviews and advises on each other’s difficult cases.

The case continues.