[This is the second in a series of four pieces arising from my recent, and in some ways still ongoing, experience with an obscure and distressing skin affliction apparently extremely rare in adults.  They’re not just about skin, though. Is anything ever really only about what it first appears to be?]

I have no medical expertise whatsoever, and throughout a long educational career avoided science whenever I could.  Moreover, I’ve been extraordinarily lucky, compared to many other people my age, in the relative infrequency with which I have needed to consult internists and other medical specialists.  So you could say I am somewhat inexperienced when it comes to medical and pharmaceutical matters.  I’m emphasizing this up front because nothing that follows should be construed as medical advice.  However, my own recent experience with a very particular kind of non-fatal disease raises certain questions you may want to think about yourself, in whatever way seems applicable, at present or in the future, to your own health situation.

That said, I am observant.  And sentient.  And now there’s the internet, a resource not available thirty years ago, where one can look up matters of interest to oneself.   Which is not to say I don’t respect doctors.  It seems to me that most medical professionals I’ve met really do want to help those who come to them, and do the best they can with the training they’ve received in medical school.  Much of which is remarkable.  The ability to identify and name medical problems, even those coming down the pike but not yet arrived, is extraordinary — thanks to the armament of sophisticated testing equipment which has been developed in the past fifty or sixty years.  Surgeons have also become highly skilled at repairing and replacing broken and worn-out parts of the body. Valve replacements, joint replacements, cataract removal and replacement with artificial lenses.  In addition, they know how to cut bad things out of you — such as many cancers, parts of colons so inflamed that they will kill you if not removed.  And like that.

But when we reach pharmaceutical treatment, we’re on somewhat shakier ground.  There are clearly successes. Some cancers in remission for ten or more years.  Hypertension held in check, without perceptible side effect, by a combination of medications reached after trial and error.  HIV-positive no longer necessarily a death sentence.  But as Bill, my resident now-retired medical guru, used to tell his patients:  medicine is not rocket science.  Meaning — doctors don’t know everything.  Or, in some cases, very much.

Nonetheless, when you feel truly awful, who do you go to?  It’s almost instinctive: if you don’t know what’s wrong with you, go to someone who knows more.  And so, when nearly four weeks ago, I felt weak and listless, and began ceaselessly to scratch first my scalp and then my chest and back, which both soon turned hot and dotted with bumpy itchy eruptions, I betook myself to the local dermatologist, who had a look, asked a few questions, and concluded, “eczema,” or possibly an “atopic dermatitis,” and wrote out a couple of prescriptions.  To make me feel better, until it passes, he said.  Why this, and why now?  He shrugged.  “It happens.”

The prescriptions were for fifteen days of oral prednisone (to be tapered off gradually, in five day increments), for another form of steroid in topical form (to be rubbed over the afflicted parts), and for an oral anti-histamine to take at night.  He also mentioned Claritin, an over-the-counter anti-itch tablet, for daytime, because it’s not sleep inducing.

I had only once in my life broken out in what was either an “eczema” or “dermatitis” on my back and upper arms — in my early sixties, when I was enrobed in professional, emotional and practical stress of almost every kind you can think of, and my skin decided to protest.  That was twenty years ago, and the dermatologist I consulted at the time prescribed an earlier version of a topical steroid, plus an anti-histamine, plus immersion in some kind of colloidal substance that coated the bathtub as well as me, so as to soothe the irritated skin and make the tub nearly impossible to clean. In two or three months, the condition went away and never came back — whether because of the “treatment” or because the problems in my life began slowly to resolve themselves, I don’t know. (Interestingly, the dermatologist had predicted that it would return every winter from then on.) Without speculating further on an issue of the past long since resolved, what I conclude from this is that in twenty years, nothing much has changed:  steroids and anti-histamines for problems of the skin, about which little is apparently understood.

Except that now, twenty years later, the local dermatologist was wrong in his diagnosis. I began to turn boiled-lobster red as the hot, itchy eruptions ran together, and they also moved steadily downwards, in five or six days covering face, arms, tops of hands, lower torso front and back, legs and tops of feet (although I had already begun taking the oral prednisone, as well using the other stuff) — until all of me other than my palms and the soles of my feet were afflicted.  Bill consulted the head of dermatology at Cornell-Weill in New York. He recognized it at once from its symptoms as described. It wasn’t eczema at all.  It was apparently a “general viral exanthem.”  An attack on the skin by a virus. It would eventually go away on its own.  Should I continue with the prednisone?  Yes:  once you start, you shouldn’t stop until the prescribed course is finished.  And it might do some good.

So let us consider prednisone, and other corticosteroids (of which prednisone is one) — the dermatologist’s go-to medicine for problems of skin. [The specific information in this post about corticosteroids comes from the Mayo Clinic’s website section on steroids.]  Steroids are the kind of medication accompanied by the caution that “your doctor has determined the benefits of taking this medication outweigh the risks.”  I have known two people for whom the benefits certainly outweighed the risks, but what was at issue was not skin.  An old college friend was gasping for breath from asthma, and corticosteroids saved her life.  They also made her, a formerly slim attractive woman, blow up (as my mother would have said) like a balloon.  But if the choice is thin and dead or fat and alive, which would you choose?  Similarly, one of the two cleaning ladies who visit us twice a month to keep our condo nice and clean is suffering from rheumatoid arthritis.  She is in her early fifties and if it were not for steroids, she wouldn’t be able to function.  She too is quite plumped out, although her daughter says she used to be a tiny petite little thing.  There are also other future worse side effects of long-term continued use of whatever form of steroid she is taking, some of which she is aware of.  But does she have a choice?  I understand corticosteroids are further helpful in auto-immune diseases, such as lupus, where the immune system attacks the body’s own tissues.

But why is it prescribed for skin conditions? Because corticosteroids mimic the effects of hormones the body produces naturally in your adrenal glands.  When prescribed in doses that exceed the body’s usual levels, corticosteroids suppress inflammation, and thereby can reduce the signs and symptoms of inflammatory conditions.  Alas, they also suppress your immune system. Furthermore, after seven days of doses exceeding the body’s usual levels, the body shuts down its own production of anti-inflammatory hormones, so if you stop taking synthetic corticosteroids suddenly, you will be left without any protection at all against body invaders.   The synthetics have to be tapered off gradually, so that your body picks up the cue that it’s time to start functioning normally again.  Even when you’re no longer taking them, the Mayo Clinic warns that you may feel fatigue and lightheadedness for a while.  Yes, I did, for almost a week after the last pill.  And I’m not fully recovered yet, another week later.

Did it help at all?  Presumably, it was intended to shorten the duration of my affliction — my body’s reaction to the virus — and lessen the inflammation (and therefore the severity of the “discomfort.”).  A general viral exanthem is supposed to last ten to fourteen days.  My inflamed and burning redness faded on the eighteenth day. Today, twenty-eight days after the initial outbreak, my legs — the last to suffer — are still slightly blotchy, and the rest of my skin, although looking normal again, still hypersensitive to touch and hyper-responsive to any form of gentle scratching.  You could say that my age was a factor in delaying complete recovery within the predicted period.  But you could certainly also say that the oral prednisone — the form that affects the entire body — did nothing to shorten the recovery period.  Did it lessen the inflammation?  As I don’t see how it could possibly have been worse (other than to enter the inside of my mouth, which it didn’t do), I answer this question with a clear negative.  So much for the benefits.

Prednisone comes from the pharmacy accompanied by a multi-page printout of possible side effects.  These are the ones I experienced, at first without knowing what was causing them, as I was too tired and confused to start researching this subject until about ten days ago:  Confusion, dizziness, spinning sensation, dry mouth, dry lips, extreme thirst, extremely increased urination (up almost every hour at night), limp feeling, gradual weight gain (two and a half pounds in two weeks despite watching what I ate like a hawk), trouble thinking, trouble speaking — I was groping for words, me! — at times slightly blurred vision, cough, hoarseness, runny nose (without having a cold), shaky hands, chills. I paid less attention to all this than perhaps I should have because I was almost entirely focused instead on the misery of the burning skin, the rash and the itch.  However, I will note, gratefully, that the side effects I didn’t get, perhaps because the course of treatment was relatively short, are even scarier — and include, of all things, skin rash!  Again, I will concede that my reactions were likely exacerbated by age and my body’s inexperience with pharmaceutical substances that tinker with its chemistry.  That, however, was a question of degree, and does not alter the risk/benefit analysis.

[One word about the oral anti-histamine, to be taken at night:  It put me to sleep for about three hours until I woke myself up scratching, still groggy from medication.  So it didn’t really work, either.  As for the Claritin — ditto, and it didn’t take three hours to find out.  Perhaps it helps with something really mild.  Whatever that may be.]

As for the topical steroid ointment, to be applied at judicious intervals to the “afflicted” parts  — even if it had helped, it was a greasy mess to apply (all over!) and precluded the wearing of anything but a long loose nightgown for the four days I kept with it.  I did not keep with it after that because it soon became clear that applying it was counter-productive.  It cooled things down for about five minutes once I had anointed all of myself, and then everything flared up again worse than before.  I will not speculate as to why. Perhaps the inflammation was more determined than the ointment, and refused to be put down!  I have subsequently found some evidence online that this can happen; topical steroids can begin by suppressing inflammation and end by further encouraging it. But as I have now packed all that away in a box labeled “Itch Stuff” (which I suppose will get thrown out in due time, but not quite yet), I will not think about it again, because there are now other things to think about.

Such as: What should I have done when all this began?  My personal opinion is now that corticosteroids are bad news unless you are going to die without them.  They are certainly bad news for skin. And especially as you get older.  There are other ways of dealing with the extreme discomfort of skin rashes, whatever you call them and whatever caused them, that do not carry the heavy burden of side effects that accompany the questionable benefits of steroid application.  (Cold packs wrapped in a towel or washcloth at night, lukewarm showers with Dead Sea salt soap, oatmeal baths, liberal and frequent application of Aloe Vera lotion and — even better — Calendula lotion, which is said to have some healing properties. Wear cotton against your skin; avoid wool and synthetics while you’re inflamed. There’s more, but I won’t continue, unless someone asks.)  On the other hand, when you are truly afflicted in your skin,  or anything else that requires medical attention, do you meekly submit to the pharmaceuticals offered on prescription, or do you dare challenge authority?  Should you emulate Job’s wife, and disbelieve?  Do you curse steroids, and set off on your own, at the risk of metaphorical death (that is, increased suffering)?

At a minimum, if I were doing it again, I would ask Dr. Dermatologist hard questions I didn’t ask.  (Shame on me, the retired lawyer.) What would happen without the steroids?  What are their side effects?  Is this a good idea at my age?  What is the least amount of “treatment” possible? What else can I do to relieve myself?  And even — are you sure I have what you say I have, and how do you know that? And if it isn’t that, but something else entirely (such as a virus attacking the skin),  would the steroids be any use at all?

Then when I had got past all that, and come to whatever decision I had made about following the medical directives I had been given and not looking elsewhere for relief — the fact that I had made it being important here — I would feel better about the consequences, since I had knowingly chosen them and had not had them imposed upon me because “doctor knows best.”

I would also resolve that if I could possibly help it, my immune system would not again so easily yield to viruses and other unseen evils afloat in the world.  I would figure out what I could do to make whatever future I have left as safe and comfortable as possible. But that’s a subject for another day.






[This is the first in a series of four pieces arising from my recent, and in some ways still ongoing, experience with an obscure and distressing skin affliction apparently extremely rare in adults. They will not be just about skin, though. Is anything ever really only about what it first appears to be?]

When I announced that I would be absent from The Getting Old Blog for a while because I had come down with what was initially diagnosed as eczema but then turned out to be something else entirely, I described it like this:  “It’s a scalp-to-toe proposition, front and back … and makes you feel like Job.  (In my case, female version.  Was there a Mrs. Job?)”

That last bit about Mrs. Job was a throwaway line, to lighten things up.  The only time I had looked at the Book of Job — and “looked” is the appropriate word here — was for a class in Classical and Christian Civilization sixty-five years ago.  And all I retained of that long-ago cursory flipping of the pages was that the God of the Old Testament had put good and pious Job through many painful trials, including boils, to test his faith.  I didn’t even remember how it came out in the end.

Fortunately, I have at least one better-informed reader, who stepped up to the plate at once.  ShimonZ replied:  “Yes, there was a Mrs. Job…and her story was what first turned me against the entire tale, though it is reputedly written by Moses himself.  She died just to make Job unhappy…and after he’d proven how faithful and innocent he was, she was replaced!”

However, by the time Shimon’s comment reached me, my head was spinning with medication side effects, and I was unable to process anything about this new information other than that the loss of his wife was simply one more punishment God imposed on Job to determine how steadfast was his faith. That didn’t seem exactly fair to the wife, but I had other more skin-specific things on my muddled mind just then, and if I had to think about fairness to anyone, what about me?  (It usually all comes down to that in the end, doesn’t it?)

But once my brain had cleared, I looked into the matter further  — online, of course — and see that there is much confusion and controversy concerning the significance of this wife, of whom I had not known, during the course of God’s testing of Job’s faith.  She shows up in the Book of Job only once, after her husband has lost his wealth, his flocks, his seven sons and three daughters (who were also her seven sons and three daughters), and has been afflicted with loathsome disease. At this point, she asks him a question. Then she tells him what to do, irrespective of the cost.  He remonstrates with her. (No, no, bad wife.) And then she disappears.  That’s all there is:  one sentence, over and out.

Where there’s so little textual data, there’s plenty of wiggle room to go where you will with the story, and both Christians and Jews have had at it with vigor over the intervening centuries.  But why would this interest me — a person freshly risen from her sickbed who is not religious in any formal, or even informal, sense and has never engaged in textual, much less Biblical, exegesis either professionally or in some search for inner truth?

Because, put simply, I ask questions too.  When unforeseeably bad things happen, I am not docile. In the end, I may have to accept them.  But not before trying to find out why. And so, without knowing more, I was at once on nameless Mrs. Job’s side.  In her circumstances, I would have done and said exactly the same thing.  More specifically, an unforeseeably bad thing had just happened to me, and I was asking some questions and trying to decide what to do about preventing the next unforeseen bad thing.  No more blind faith in Dr. Dermatologist for me!

Guess what?  Asking big questions about blind faith has been a big no-no for a long time, and even more so if you’re “just” a woman.  Here’s one relatively recent take on the matter — both misogynist and repugnant — from http://www.biblegateway.com.

Job’s Wife: The Woman Who Urged Her Husband to Commit Suicide

Strange, is it not, that … we do not have the name of [Job’s] wife who remained at his side all through his trials and tribulations?  She is identified by only ten words which she uttered to her husband as she saw him suffering from so much bodily pain and discomfort.  ‘Dost thou still retain thine integrity?  Curse God, and die,’ or ‘Curse God and die by your own hand.  End your suffering by taking your own life.’  She urged him to commit suicide and thus relieve himself of further anguish.

Actually, this alternative reading — ‘die by your own hand’ — appears to be the commentator’s interpretation of ‘and die.’  I myself would have assumed that cursing God in the Old Testament World would have brought a punitive death at God’s hand –which is, I suppose, a sort of suicide, but not exactly where the commentator seems to be going here:

There was also the diabolical suggestion that [Job] should relinquish his faith in God, seeing He was permitting him to endure such terrible physical torment and material loss.  It is because she allowed Satan to use her as an instrument to grieve rather than comfort her husband, that commentators have spoken ill of her character.  Augustine referred to her as ‘The Devil’s Accomplice’ and Calvin wrote of her as ‘An Instrument of Satan’ and as a ‘Diabolical Fury.’ The little she said to her husband whose heart was at breaking point was enough to crush him altogether.  The one closer to him than all others should have encouraged him and offered him human sympathy.  Job’s wife, however, was the female foe in his household and reminds us that ‘the worst trial of all is when those nearest us, instead of strengthening our hand in God and confirming our faith, conspire to destroy it.’ (Micah 7:6; Matthew 10:36)

What does biblegateway suggest that Mrs. J. should have said or done when confronted with the pitiable sufferings of her ravaged husband (not to mention what must have been her own)?

…..Job was determined not to sin with his lips as his thoughtless wife had done….Because God has given woman an affectionate heart, and a large capacity for sympathy and compassion, it is incumbent upon women…. to ….persist in encouraging [their husbands] in times of great trial and tragedy.  It is only thus that a woman functions as God meant her to, as an ‘helpmeet.’ © 1988 Zondervan. All Rights Reserved.

Woman as mindless helpmeet. Heavy stuff. Enough to turn the most ardent believer into a feminist.  If this was the male mindset in Job’s day, can you blame Mrs. J. for disappearing from the text?  Luckily, there is another way of construing the Job family situation:

Wife of Job: Bible  by Ilana Pardes

[from the Jewish Women’s Archive, http://jwa.org.]

In the well known biblical story dealing with the problem of undeserved suffering, Job loses his [ten] children, his possessions, and his health.  Job’s nameless wife turns up after the final blow, after Job has been struck with boils.  Seeing her husband sitting in the dust, scraping his sores silently, she bursts out, ‘Do you still persist in your integrity?  Curse God, and die.’ (2:9)  She cannot bear her husband’s blind acceptance of the tragedies that befall them.  Indeed, the attention to Job’s suffering usually ignores the fact that she too, after all, is a victim of these divine tests in addition to being pained by exposure to his afflictions. (19:17) To cling to a model of perfect devotion to a supposedly perfect God when reality is so far from perfection seems to Job’s wife to be not exemplary strength, but an act of cowardice.  Such ‘integrity,’ she seems to be saying, lacks a deeper value.  What Job must do is to challenge the God who has afflicted him so, even if the consequence is death.

Much has been written about the unusual challenge the Book of Job offers in its audacious questioning of the ways of God, but one never hears of the contribution of Job’s wife to the antidogmatic bent of the text. …She opens the possibility of suspending belief, of speaking against God.  Job’s initial response to his wife’s provocative suggestion is harsh: ‘You speak as any foolish woman would speak.  Shall we receive the good at the hand of God and not receive the bad?’ (2:10)  When the dialogues begin, however, Job comes close to doing what his wife had suggested.  He does not curse God directly, but by cursing his birth he implicitly curses the creator who gave him life.  Much like Eve, Job’s wife spurs her husband to doubt God’s use of divine powers.  In doing so she does him much good, for this turns out to be the royal road to deepening one’s knowledge, to opening one’s eyes.

Job’s wife disappears after her bold statement…. [She] is conspicuously absent from the happy ending in which Job’s world is restored. Job’s dead children spring back to life, as it were, because he ends up having, as in the beginning, seven sons and three daughters.  Yet his wife, who actually escaped death, is excluded from this scene of family bliss.

But that’s okay, because it’s the family bliss of an Old Testament world, where ten new children by a second wife [Dinah, daughter of Jacob] can replace ten dead children, and a wife, similarly replaceable, is a mere extension of her husband. Not really something you or I would want for ourselves or our families.  You see, there’s more, only it’s not in the Bible.  According to the apocryphal Testament of Job, Job’s wife did have a name.  It was Sitis, or Sitidos, and she was, in a way, an outsider:  a woman of Arab descent. So what I would like to think is that she went away and made a whole new life for herself as Sitidos, a woman with a mind — far from undeserved suffering inflicted on her to test her husband’s faith.

This piece may have seemed like a wandering through the wilderness.  It wasn’t.  What began as an idle posting reference to Job, or Mrs. Job if there was one, turned out to be useful and fortifying in thinking for myself about my own recent “ailment.”  Although my immediate response to unforeseen misfortune may be to hurl myself on the nearest mattress, sob, shake my fist at the plaster ceiling and cry out, “Why me, oh God? — eventually, as in the words of the song, I do pick myself up, dust myself off, and start all over again. Which is what I did when the worst of my recent affliction began to resolve itself.  But where and how to start?  Learning about Sitidos taught me something:  If the status quo fails you, curse it and look elsewhere.  You probably won’t die.  She didn’t.