Living legend in dermatology-Professor Amrinder J Kanwar

YEAR-WISE CURRICULUM VITAE

WHAT BROUGHT YOU IN THIS FIELD?

Before I spell out why I became a dermatologist, I would like to say how and why I decided to become a doctor. My father was diabetic and hypertensive and would regularly go to hospital for treatment. As a kid, I would also accompany him along with my mother. I distinctly remember that in 1955 standing at the Safdarjung bus stop and looking at the AIIMS, Delhi building, he said how he wish if one of his sons receives medical training at this prestigious institute. That day I decided that I would become a doctor so that I could take good care of my father. Unfortunately, he died in 1960. I kept his wish and 5 years later, I was at AIIMS in 1965 how I wish my father was alive to see his wish fulfilled.

What attracted me to dermatology was the fact that one could make a diagnosis instantly; SPOT diagnosis as it is called. I realized during my undergraduate posting in dermatology during the final year that I could easily make a diagnosis of lichen planus and psoriasis. Prof. L K Bhutani was impressed by my ability to make a spot diagnosis. His words of appreciation further encouraged me. In the final MBBS examination at AIIMS, a dermatology case is kept in the examination. I could easily make the diagnosis of xeroderma pigmentosum much to the delight of Prof. K.C Kandhari, HOD Dermatology. My interest in dermatology started growing after passing final MBBS examination in December 1969. I did 1-month elective internship in dermatology. During this period, I came in close contact with Prof. J.S Pasricha and Dr. O P Singh. I was thoroughly impressed with the working environment in the Department of Dermatology I realized that this is a specialty where there is much to learn and do research on. Dr. O P Singh told me clearly that it is easier in dermatology to get into academics as compared to other specialties.

As destined by the almighty, I got married during internship. As luck would have it, I wanted such a specialty where one could spend more time with my partner and family so at the end I would say that it was my marriage which sort of compelled me to take up a specialty where I could afford more social time. After my marriage (during internship), in our times, it was mandatory for us to do 1-year house job (6 months) in two specialties. I had some where at the back of my mind that if one has to go to the UK for higher studies one has to have a house job for 6 months in medicine and 6 months in surgery. So, for surgery, I choose urology and for medicine, dermatology. That is how I made dermatology my career. However, I was so scared of Prof. Bhutani that I did not let him know throughout the 6 months of house job that I was married.

WHO WERE YOUR MENTORS?

Prof. L.K Bhutani and Prof. J.S Pasricha played a pivotal role in my training in dermatology in early years. My thesis on atopic dermatitis under Prof. J.S Pasricha initiated me into pediatric dermatology. In Benghazi, Libya, Prof. Y. K Malhotra inculcated in me the zeal to write and publish. At PGI, Prof. Surrinder Kaur made me realize the importance of internal medicine in dermatology. At the St. John Institute of Dermatology, London, four persons played a significant role in molding my career, Prof. Malcom Greaves, dean at St. John Institute could bring out my clinical sense with appreciation during the grand round and he made me work on chronic spontaneous (auto immune) urticaria. Prof. Martin black stimulated my interest in blistering disorders and Dr. B.S Bhogal taught me the basics of immunofluorescence Prof. David Atherton sharpened my skills in pediatric dermatology. Sitting in his clinic and learning pediatric dermatology was a memorable experience. The large glass windows opening toward Big Ben and sounds of the clock every fifteen minutes are still fresh in my mind.

Here, I would like to share an interesting experience. Dr. Robin Russel Jones an eminent hisotopathologist at St. John’s Institute was chairing the grand round on Thursday. We knew each other well as he was a visiting Professors to university of Garyounis, Benghazi Libya when I was there he opened the session saying that he would like me to discuss a case in a young individual who has scaly crusted papular lesions in seborrheic distribution and his father also has similar lesions. In a split second, I said Dr. Russel we have Darier’s disease to discuss, everyone was impressed and I made my day at St John’s. Dr. Neil Creamer, another histopathologist and one of the editors of Rook’s Textbook of Dermatology taught me histopathology every week during my time in St. Johns Institute.

Later on in my career, Prof. Hashimoto, Kurume University, Japan, in 2010 made me do excellent basic research in blistering disorders and I had the opportunity to see many interesting cases with him in his skin OPD and then every Thursday from 4 to 9 pm the whole department would discuss the cases seen in the entire week with clinical photography, histopathology, and management. The social events following Thursday meets were a memorable experience in itself.

WHO MADE YOU LEARN MOST?

Although I learned from all teachers, I would single out Prof. J.S Pasricha as the one who made me learn most. I would sit with him in his OPD, take history from patients, and then present him the case. He would immediately let me know my mistakes and rectify calmly. In fact of all the faculty members, he was most approachable and as a resident I never felt any stress or tension in asking questions. As my thesis guide, he was very cooperative and dictated me the whole discussion verbatim. He advised me to present my thesis work at the First Pan Pacific conference of Allergy and immunology held at Bombay in 1973. It was a grand success. His interest in blistering disorders motivated me and I owe my work in blistering disorders to him.

LIST OF 10 BEST PUBLICATIONS

1. Singh OP, Kanwar AJ. Lichen planus in India: An appraisal of 441 cases. Int J Dermatol 1976;15:752-6.

2. Kaur S, Kanwar AJ. Dexamethasone-cyclophosphamide pulse therapy in pemphigus. Int J Dermatol 1990;29:371-4.

3. Kanwar AJ, Dhar S, Kaur S. Evaluation of minor clinical features of atopic dermatitis. Pediatr Dermatol 1991;8:114-6.

4. Kanwar AJ, Kaur S. Pemphigus in children. Int J Dermatol 1991;30:343-6.

5. Dhar S, Kanwar AJ. Epidemiology and clinical pattern of atopic dermatitis in a North Indian pediatric population. Pediatr Dermatol 1998;15:347-51.

6. Kanwar AJ, Kaur S, Thami GP. Long-term efficacy of dexamethasone-cyclophosphamide pulse therapy in pemphigus. Dermatology 2002;204:228-31.

7. Kanwar AJ, Dogra S, Handa S, Parsad D, Radotra BD. A study of 124 Indian patients with lichen planus pigmentosus. Clin Exp Dermatol 2003;28:481-5.

8. Beissert S, Mimouni D, Kanwar AJ, Solomons N, Kalia V, Anhalt GJ. Treating pemphigus vulgaris with prednisone and mycophenolate mofetil: A multicenter, randomized, placebo-controlled trial. J Invest Dermatol 2010;130:2041-8.

9. Kanwar AJ, Tsuruta D, Vinay K, Koga H, Ishii N, Dainichi T, et al. Efficacy and safety of rituximab treatment in Indian pemphigus patients. J Eur Acad Dermatol Venereol 2013;27:e17-23.

10. Kanwar AJ, Vinay K, Sawatkar GU, Dogra S, Minz RW, Shear NH, et al. Clinical and immunological outcomes of high- and low-dose rituximab treatments in patients with pemphigus: A randomized, comparative, observer-blinded study. Br J Dermatol 2014;170:1341-9.

LEADERSHIP ROLE

I got an opportunity to head the newly formed Department of Dermatology and Venereology at Government Medical College, Sector 32 Chandigarh from 1996 to 2001. It was a deputation from PGI, Chandigarh, during these early years. I did my best to bring the Department at a level matching the Dermatology Departments at PGI and AIIMS. Everything was procured in the shortest possible time. This included equipment, books, and the faculty. Various clinics were started on the pattern of PGI. These included pediatric dermatology, leprosy, psoriasis, urticaria, and dermatosurgery. The attendance of patients both outpatient and inpatients improved remarkably and I was happy that I could create a department competitive to that of PGI. I could not stay there longer as my deputation from PGI was soon going to be over and I did not want to lose my seniority at PGI. At this juncture, I would like to express my sincere thanks to the then Director PGI, Prof. S.K. Sharma who was instrumental in motivating me to join back PGI. Incidentally Prof. S K Sharma Director PGI was my Registrar during my house job in urology at AIIMS from January 1971 to June 1971. I will be ever grateful to him for his guidance and advice.

So I was back to PGI in August 2001. As 9/11 happened, there were 2–3 most horrible days of our life as we could not get any news about the safety of my elder brother who was in the second tower of the world Trade Centre. He is also as punctual as me reaching office exactly at 9 AM, at about the time the first tower was blown. He could run down to safety from the 6^th floor of the second tower as this was evacuated immediately minutes after the first tower was hit. We thanked the Almighty as we got a call from him on the 3^rd day about his safety. It was a nightmare indeed.

I became the Head of The Department of Dermatology at PGI in January 2005. Just a month ago, my mother had expired in private wards of PGI. How I wished she had been alive to see me heading the best Department of Dermatology in the Country. The time spent by me as Head of the Dermatology Department in PGI would stay in my memories forever, as it was the most beautiful period of my Life.

While at the PGI during my OPD days, I ensured that all new patients are seen by me. A patient’s friendly and resident friendly environment was created much to the enjoyment of every one. I was able to hold the National Conference of Indian Association of Dermatologists, Venereologists and Leprologists, The DERMACON 2008 at Chandigarh. Besides, the National faculty, DERMACON 2008 was attended by many international faculties which included Prof. Malcolm Greaves, Prof. Orange, Prof Neil Shear, and Dr. B.S Bhogal. It was a great success. I also attended several international conferences in Europe, Canada, Serbia, Czechoslovakia, South Korea, Australia, Libya, Argentina, Brazil, China, the UK, and the USA, wherein I was able to present Indian research to international audience.

The department was able to get several drug trials during my tenure. The most significant among these were a multicentric international trial about use of mycophenolate mofetil and its steroid saving effects in management of pemphigus. Our department was able to contribute the largest number of pemphigus patients to this trial.

I am pleased and happy to say that during my tenure everyone was provided an equal opportunity to carry out research and work in his/her field. Of the 3 Kataria Gold medalists from the Department of Dermatology since its creation, one was during my tenure as HOD. As I retired in June 2013 many of my students have made a name for themselves both at national as well as international level. I would like to just name a few Dr. D M Thappa, Dr. Sandipan Dhar, and Dr. Rashmi Sarkar. The 26 ½ years spent at PGI are the best productive years of life. However, I am very sad and disheartened to say that I was not given a farewell by the department, which is the usual protocol. All this was due to petty politics. Whenever I visit Chandigarh, I do go to PGI, but not to the Department of Dermatology as it kindles this sour memory in my heart.

After my retirement, I joined the Department of Dermatology at Sharda Hospital, Greater Noida as Professor and head. I stayed there for 4 years, the undergraduate teaching was modernized and the OP attendance picked up, laser and photography units were procured so that postgraduation in dermatology could be started. I am pleased to share that finally postgraduation in dermatology has started there.

I always enjoyed my leadership role and as they say I led from the front.

ACHIEVEMENTS AND REGRETS

The best achievement in my life was when I was selected to get the Dr. B.C Roy award for an eminent medical Teacher in 2016. I shall never forget the time (it was about 4 PM) when sitting in my clinic at Noida in a hot day in May 2016 and scrolling through my email on the mobile, I read the mail where it was intimated to me that I have been selected to get this prestigious award. I could not believe my eyes. I read it several times to convince myself and then I broke the news to my family members. My joy knew no bounds. It was the best achievement of my life till date.

The greatest regret in my life or should I say the blunder which I have been lamenting throughout my life has been as to why I did not go to the USA after I had cleared the ECFMG held in Colombo in February 1970. I will never excuse myself for this blunder. My children also tell me the same. As they say opportunity comes only once in life and I missed that. When I learn and hear about my batch mates settled in very good academic positions in the USA, my heart skips a beat.

ANY SIGNIFICANT EVENT TO REMEMBER

There are quite a number of significant events to remember. The top most among there is the time spent at Durbar Hall, Rashtrapati Bhawan on July 1, 2016, when I was to be awarded the Dr. B.C Roy award by the honorable President Shri Pranab Mukerjee. The sound of National anthem played by the police band when the President has reached The Durbar Hall is awesome. It is difficult to express it in words. At the award presentation ceremony, me telling him that he was the chief guest at the Annual convocation of PGI a few years earlier and on hearing this, him shaking hands with me (out of protocol) are perhaps the best moments of my life not to mention the high tea which followed the award. My wife and son were present during this ceremony. This one in a lifetime opportunity and would always remain in my memories as the most significant event.

One other event that I would like to remember is that when in 1995 at The St. John’s Institute of Dermatology, London, Prof. Malcolm Greaves gave me an opportunity to present a case in the Consultant’s meeting on a Thursday. I was very excited and tensed up a bit. It was the 1^st time that a commonwealth fellow had been given such an opportunity. The presentation went well and was very well appreciated.

Finally, my lecture at the invitation of the President of British Association of Dermatologists (BAD) during The Annual convenience at Glasgow, in July 2014 on Vitiligo – an Indian perspective made me feel proud as I could do justice to the topic and it was applauded. Besides the presentation, I extremely enjoyed the hospitality offered.

TEN MOST INFLUENTIAL PROFESSIONALS IN YOUR FIELD

• Dr. David Atherton, London

• Dr. B.S Bhogal, London

• Prof. L.K Bhutani, AIIMS, New Delhi

• Prof. Martin Black, London

• Prof. Robin Graham Brown, London

• Prof. Christopher Bunkur, London

• Prof. Malcolm Greaves, London

• Prof. J.S Pasricha, AIIMS, New Delhi

• Prof. Neil Shears, Toronto, Canada

• Dr. O.P Singh, AIIMS, New Delhi.

FUTURE IN THIS FIELD

Dermatology as a specialty has come a long way in the past 50 years. The pathogenesis, diagnostic techniques, immunology, immunopathology, immune pharmacology, dermoscopy, therapeutic interventions, lasers, and dermatosurgery have all made it a very interesting specialty. It is not far when we shall soon have DM courses in say dermatopathology, dermatosurgery, and pediatric dermatology. However, I feel these days the students choose dermatology just as an initial step to later set up their practice as a cosmetic dermatologist or as a laser specialist. The concept of clinical dermatology is just not there. This is something I am worried about. Botox, fillers, and hair transplants are what most of the young dermatologists are doing. This is not a healthy trend. It is for the office bearers of Indian Association of Dermatologists Venereologists and Leprologists to look into. Sadly, there is lack of high-quality teachers. When one is at his/her peak, one has to retire. This needs to be looked into.

Note: Living legend in dermatology-Professor Amrinder J Kanwar interview was conceived and conducted by Devinder Mohan Thappa.