SEATTLE, WA – Aspiring dermatologist and fourth-year medical student, Joshua Bitters, has discovered the first physical exam finding that uses the average physician’s least used sense: taste.
The physical exam maneuver becoming known as the Bitters sign will revolutionize the dermatologist’s approach to psoriasis, a diagnostically-challenging skin condition. Testing for the sign requires little formal training, but the test is significantly more sensitive for psoriasis than the Auspitz sign, another popular exam finding taught in medical school for diagnosing psoriasis.
Mr. Bitter’s paper, scheduled for publication in the hard-hitting journal Diagnostic Dermatology outlines a standardized approach to testing for the sign. After collecting a specimen of the lesion with a shave biopsy, the physician must taste the lesion with the anterior portion of the tongue two times, with a minimum of 30 seconds between licks to allow for cleansing of the palate. The Bitters sign is considered positive if during both licks the taster involuntarily contracts the facial muscles responsible for the emotion disgust. The contractions are similar to the tensing of the abdominal muscles seen in involuntary guarding.
Joshua discovered the sign during his Dermatology elective, when he was asked for his diagnosis regarding a maculopapular morbilliform plaqueish rash they had just biopsied. After licking the specimen in anxious fear, he blurted out the correct diagnosis, “Psoriasis!” The unique flavor profile and texture, described by Joshua as “the grittiness of fried chicken skin with the fishiness of raw tuna,” was too unique not to be related to the underlying pathology. Joshua went on to lick hundreds of specimens to refine the protocol for evaluating a possible Bitters sign.
Hundreds of dermatologists have already lauded the Bitters sign as “the best discovery by a medical student since Mohs surgery.” Other physicians have questioned the practicality of “licking a piece of dead skin.”