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Scales of Injustice

Posted by Frederick Wasti
Oct 22 2012

I have been battling a couple of skin rashes over the last few weeks. (Ugh.) I'll discuss the first one here, and I'll talk about the second one tomorrow (I promise).

The first rash to "rear its ugly head" (no pun intended) has resulted from a pretty good (actually, pretty bad, I guess) case of seborrheic dermatitis on my face and neck. There's a pretty good explanation of seborrheic dermatitis in an article on Wikipedia (that uses the British spelling of "seborrhoeic dermatitis") which you could check out, if you've never heard of it before.

About a month ago, I started getting "seb-derm" (a cute nickname for something that's really not too cute itself) on my face, my ears, and much of my neck. In a lucky coincidence, I happened to have my yearly appointment with my regular dermatologist (Dr. Ramzi Saad of Cohasset) scheduled for a few days after this started, so the timing for my skin checkup seemed to be perfect. He diagnosed the rash as seb-derm and prescribed for it a topical antifungal medicine, Econazole Nitrate (trade name Spectazole), a cream that I simply had to spread (or smear) all over the affected areas a couple of times a day.

It turns out that seb-derm is caused by any one of several fungal species (yeasts, usually) which all of us already have on our skin, but which usually don't bother most of us most of the time. Generally our immune systems do a pretty good job of keeping these fungi in check, although in some people, using a so-called "dandruff shampoo" is needed to help out on the scalp. (The same yeasts sometimes cause a condition called "cradle cap", which some babies temporarily develop on their scalp, until their own immune systems mature to the point where they can fight it off.)

However, because CLL is a disease of the immune system, and because the treatments I have been receiving for CLL have necessarily weakened my immune system even more than the CLL itself, I guess that the seb-derm fungi finally "got the better of me" in this case. And, although I had already sort of figured out this possibility on my own, my dermatologist gave that as his opinion as well.

However, even after starting the Econazole treatment (putting the goop on my face, ears, and neck twice a day), the seb-derm kept getting slowly worse (both more widespread and more inflamed). So, I called my dermatologist's office about this and was told (in a return phone call from one of the staff persons there) that I just have to give it more time to work, that it takes 10 to 15 days to do its job.

Well, OK, but by then it had gotten so that my entire face, my ears, and nearly all of my neck had gotten quite red and very scaly, and, in addition, some of my face (below my eyes, and on either side of the nose and mouth) had started getting rather puffy - I then had what I called "double bags" under my eyes - <grin>. I thought that the medicine itself might be causing the puffiness, but the staff person at the dermatologist's office said that the puffiness was instead due to the dermatitis attack.

So, I finally decided to get my Dana-Farber medical people involved. I emailed my nurse practitioner (Michele Walsh) about the seb-derm, cc-ing my doctor (David Fisher) with the message, and they both saw me the next day that I was at D-F for treatment, and they arranged for a staff dermatologist (Marianne Tawa, who usually works with skin cancers, of course) also take a look at my face, and she said to continue applying the Econazole, but she also prescribed a topical steroid called Desonide (trade name Tridesilon, supposedly stronger than the usual over-the-counter cortisone creams) for me to also smear over my face twice a day - this was supposed to help with the inflammation and the puffiness, while the Econazole should continue to fight the yeast invader.

The ~good~ news is that the combination of Econazole and Desonide seems to have worked - the seb-derm is now almost totally gone "as we speak" - Hooray!

There is one funny "Catch-22" aspect of CLL and seb-derm: One of the preventions and one of the treatments for seb-derm is sunlight (it seems that the yeast is killed or at least inhibited by UV light). However, over the last few months I have been intentionally staying out if the sun (even wearing a silly wide-brimmed hat when I'm outside, instead of my usual baseball cap), because my CLL treatment has depleted most of my T-lymphocytes, which are needed to help protect against skin cancers. So, in keeping out of the sun, because of CLL, I may have actually have helped bring on the seb-derm attack, and then I am supposed to avoid treating it by using the sun, again because of CLL. Well, going with the concept of "everything in moderation", I do have to admit that, on a few occasions as of late, I've sat in the sun for a while without any hat at all, letting the sunlight have its warming way with all those pesky little yeast parasites - <smile>.

Categories: Leukemia