[This is the third 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 only about skin, though. Is anything ever really just about what it first appears to be?]
Until things go wrong, most of us fail to appreciate the ability of our bodies to protect us from the innumerable, frequently unseen enemies outside our skins that would invade and take us down if they could. That ability is lodged in our immune system, and when it’s doing the job it was intended to do we never even know what we’re escaping. Our bodies may provide an ideal environment for viruses, bacteria, fungi, parasites, but our immune systems prevent or limit their entry. Without going much further into how immunity works, which I am insufficiently knowledgeable to be able to do anyway, let’s just observe that it is provided by a network of cells, tissues, and organs that collaborate to protect us from invasion and infection. We get some of this protection from our mothers at birth; we develop the rest of it from adaptation to the dangers with which we are threatened as we grow.
However, even in a healthy adult, the fully functioning immune system is not impervious to breakdown and failure to defend. Major stress can eventually compromise it or shut it down and render you vulnerable. So can an external “enemy” too powerful for the immune system to overcome on its own without external help. (Vaccinations are one kind of such “help.”) At these times, each of us has a body that seems predisposed to go its separate way in response. Perhaps this predisposition is genetic, perhaps not. We just don’t know.
Some people are most vulnerable internally. Those are the ones who develop digestive problems, irritable bowel syndrome (IBS), ulcerative colitis. Others respond with a lung crisis, such as asthma. In still others, the immune system fails to operate properly by going crazy; in the course of trying to defend you it attacks you instead: those are the unfortunate sufferers of auto-immune diseases, such as lupus, Crohn’s disease, rheumatoid arthritis. Looking back now at my own medical history, such as it has been — and up until now I’ve been very lucky, in that it has been relatively minimal — I must conclude that my own particular vulnerability has been skin.
It first manifested itself when I was very young, with a still immature and only partially developed immune system. I am told that by the age of one, I was breaking out in hives from what was then considered healthful exposure to the sun. I certainly remember the hives of subsequent summers, until I was about five or six, when the summer sun miraculously seemed to cease to stimulate their arrival. Those were the years of endless maternal daubing with pink calamine lotion, which dried white and flaked off, and didn’t help the itch at all after the first wet cooling minutes. Also the years of, “Nina, don’t scratch! It will make it worse.” It did make it worse. Always. But how can you not scratch an itch? Even if your mother tells you not to.
Then came the mosquito bites. As an aside, I will permit myself to note that while I was doing all this research during my recent long and dreary convalescence, I discovered mosquitos only bite human beings. They’re not interested in the blood of house pets, or elephants or any other kind of animal because there’s something to be found only in human blood which is necessary to the mosquito reproductive process. In addition, some people seem to have more of this mysterious “something” in their blood than others. Count me in the appetizing group. If I’m sitting on the grass with six other people, they will escape unbitten while mosquitos feast on me.
However, that’s neither here nor there with regard to my immune system. The point is that I appear to be extraordinarily hypersensitive to whatever hostile substance mosquitos release into the human bloodstream when they sip their mosquito Viagra (or whatever it is). The mast cells in my skin (the outer Maginot line of the immune system) rush to defend me by releasing what I consider inappropriately vast amounts of inflammatory chemicals, like histamine, to combat this antagonist substance at the point of entry and mediate my allergic reaction to it. My parents, the first persons I observed, and later many others — including both husbands and Bill — did not have this problem, and therefore did not need to scratch a bite. If a mosquito deigned, rarely, to sip their blood, it left a tiny red pinprick which faded without fuss or bother. No inflamed and unsightly red circles of histamines rushing to over-protect against the invader and its venom. No swelling. No irresistible need to scrape away at the spot until it was raw. No endless itch-scratch-itch cycle leaving scabs for sometimes as long as a month after the initial bite — or, more likely, many bites. Nothing like that for them. Only for me.
Well, now there’s air-conditioning. That has pretty much taken care of the mosquito problem for me, even though I’ve lived most of my life in the hot damp stretches of the American mid-Atlantic seaboard. So I can move right along to the next skin-related immune system failure of my past.
The stress and unhappiness of my first marriage eventually produced — not colitis, to which the first husband succumbed (he was unhappy too) — but a boil, a bacterial infection of a hair follicle on my neck so large and virulent it had to be cut out at Roosevelt Hospital. (I didn’t even know there were hair follicles on the neck!) Skin again. After the incision and removal, penicillin was prescribed. Allergic reaction? You bet. Rash here, rash there, rash just about everywhere. Those mast cells were really working overtime.
Actually, I’m not a particularly substance-allergic person. Besides the penicillin, which no one has ever dared again prescribe, my only other known allergy is to erythromycin. Two tablets by mouth when I was thirty-six, and rash again, almost instantaneously — all over me (plus, in this case, ominous swelling of the joints).
Okay, enough of that. I’ve been well enough for most of my life to have had almost no experience of other later-generation antibiotics and drugs, and therefore have no more drug-induced rashes to tell you about. Whatever was administered during a right hip replacement four years ago caused no problems whatsoever. And I’ve already told you in a previous post about the one-time mysterious appearance of an “eczema” or “atopic dermatitis” that arrived to plague me in my early sixties during a period of extraordinary economic, emotional and professional stress.
So I will mention just one more thing. In August 2008, when I was seventy-seven, under the blazing sun on a tiny Greek island in the Dodecanese, I came down with a severe case of shingles on the upper right quadrant of my face. [Shingles is the disease officially known as herpes zoster.] You don’t get shingles unless at one time in your life you’ve had chicken pox. And yes, I had had chicken pox — the summer I was nineteen. [I thought I looked so awful I wouldn’t let my entirely sympathetic boyfriend come see me. Fortunately, my vanity also kept the need to scratch in check. If you don’t scratch, you don’t get pock marks. It was the one time in my life I managed to keep my fingers away from a nearly intolerable itch.]
But you don’t necessarily get shingles because of a chicken pox history. Chicken pox is caused by the varicella virus. Unfortunately, after it’s been defeated, this virus doesn’t die. Weakened, it retires to your spinal cord, or someplace like that, and lurks there harmlessly, perhaps for all of your life, kept down by your ever-vigilant immune system. But should extreme stress or very hot sun combine with a weakened immune system, the virus will arise to attack again from within, and this time it’s savage.
It is relevant here that shingles tends to strike only the aged. There’s a very expensive shingles vaccine which American insurance doesn’t cover but which does appear to offer some protection some of the time; it’s intended to boost the aging immune system against this particular virus. However, as I didn’t even know shingles existed until I fell victim to it (and neither did the only doctor on the island, who failed to diagnose it properly), I certainly didn’t know about the vaccine. But yes, we got off the island and back to America, and again I was lucky: it didn’t go into my right eye and blind me, as it might have done, and eventually it went away.
And now we come to my recent bout of “general viral exanthem” at the age of eighty-two, pushing eighty-three — and to the three-pronged question with which I began: “Why me, why this, why now?” I’ve already provided a possible, and to me plausible, answer to part of this question: I succumbed to this particular virus because it attacks the skin and because my Achilles heel has been, throughout my life, my skin. The real thrust of the question, however, is why now?
One of the interesting things I learned about “general viral exanthem” is that it manifests itself almost exclusively in very young children. Rarely, if at all, in adults. There are pictures of a four-year old boy online whose face and skin looked exactly like mine (except that he, poor little thing, had it inside his mouth, too). Very young children have not-yet fully developed immune systems.
That observation seems to me related to why, as a person whose immune system functioned extraordinarily well throughout much of my adult life — almost too well in the zeal with which it released inflammatory histamines to annihilate invaders of my skin once its outer barrier had been breached — I succumbed to stress-induced eczema in my early sixties and shingles at seventy-seven. Research has shown, although it’s evident anyway, even without the data produced by “research,” that the aging process reduces immune response capability. The elderly succumb to more infections, more inflammatory diseases, more cancer. Just by way of example, the thymus — which produces T cells to fight off infection — begins to atrophy with age and produces fewer T cells. Glutathione, the body’s most powerful antioxidant and detoxifying agent, is at its optimal level when you’re 20. After that, natural production (in the liver) drops by roughly 10% per decade. By the time you’re 60, you’re producing only a bit over half the amount you had when you went to college. By my age, less than that. A compromised liver (like mine) will generate even less.
So a virus to which I might have been impervious at forty or fifty was able to lay me, and my skin, painfully and annoyingly low for three weeks. Yes, the mast cells still did a great histamine-and-itch production job in trying to burn out the invader, but I still wish the virus had been unable to gain a foothold in the first place, so they hadn’t had to.
I concede, reluctantly, that aging is inevitable. Nonetheless, it seems to me that there are still things one can do to slow down its inroads on one’s immune system so as to keep from feeling really crappy — in whatever special way “crap” manifests itself in you — for as long as possible. One is evidently to optimize the workings of the immune system in every way one can. The other is to reduce the number of adversaries in one’s immediate environment with which the aging immune system has to contend on a day-to-day basis, thereby reducing the strain and burden on its overtaxed resources so that some reserve power remains for halting both minor and major health problems before they make themselves at home in your body. A very large subject, which I will touch on briefly next time.