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Flaky

Ronald A. Katz, MD
JAMA. 1989;262(2):282. doi:10.1001/jama.1989.03430020124043.
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It was a beautiful, warm afternoon in September when I first met Daniel. He stood rather apprehensively in the center of the examination room, dressed, it seemed, for winter. On a day when I had already seen several other students dressed in T-shirts and shorts, Daniel wore a long-sleeved flannel shirt buttoned to the neck and baggy corduroy slacks. His large, sad eyes were almost hidden by his hair, which was carefully combed down over his forehead, giving him the appearance of someone who might have been just released after being institutionalized for many years. In fact, he was a new college freshman in the school of engineering at the state university near my office, and had been referred to me by the student health service.

"Doc," he blurted, "I can't stand it anymore. I just want to be able to be with other people without having them look at me like I'm a leper, like they might catch what I have. I want to be able to hold a girl's hand, to go to the beach in the summer. Please. Please help me." As he began to undress, fine silvery scales fell freely in a shower around him. I was reminded of the forlorn snowman in a fluid-filled paperweight that would

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