Let's “Face” It...
Shortly after I moved to Kentucky in 1990, I was warned
that the Bluegrass Region, which is the southern-most
part of the Ohio Valley, is the “allergy capital of the
United States.” Severe hay fever plagued me throughout
my childhood and while I was in the service I went
through extensive allergy testing and subsequent
“hyposensitization” treatments. The tests — those
little scratch tests they do in checkerboard fashion on
your back — revealed that I was allergic to damned near
everything. The worst offenders, however, were pollen,
household dust, and common mold spoor. As a consequence
of my test results, the prescribed hyposensitization
regimen involved four inoculations a week — a regimen I
sustained until I was discharged from active duty in
here I was, seventeen years later, moving into the
“allergy capital of the United States.” I bit my lip a
little, but maintained optimism. While my hay fever had
continued to aggravate me, it was not nearly so bad as
it had been in my childhood. (For one thing, I learned
to live a little smarter. I no longer tried to picnic in
the middle of ragweed fields in August, for example.)
I'd not resumed the hyposensitization treatments as a
civilian and felt no need to. Back in Colorado, and then
in Washington, DC, seven years later, I was able to
satisfactorily “treat” my hay fever with
over‑the-counter antihistamines and nasal
There was, however, one manifestation of my life‑long
allergies that seemed to rage unabated — skin rashes.
When I was a little boy my occasional rash flare-ups
were attributed to my allergies, probably because they
tended to coincide with all the other allergy symptoms.
My allergist in the military duly noted this but never
mentioned whether he concurred or not. Since the rashes
had been a fact of life for me, I learned to live with
them. The rashes always itched, but unlike psoriasis
lesions, keeping the rashes cool and moist with lotions
and creams was an effective remedy. I learned to travel
with a ditty bag containing an assortment of emollients.
Another point needs to be made. Very little social
stigma is attached to sporting a common rash. In fact,
usually they draw sympathy and stimulate conversation.
“What happened, Ed? Get tangled up with some poison
“No, George, I decided to do battle with a nest of
Since so many things can cause a rash, I learned to spin
dozens of tall tales to boost my esteem. When I reflect
back on some of my beach and pool‑side conversations
about my rashes, I'm inclined to think that, from a
social aspect at least, a rash can be as much fun as a
nasty scar (like from a shark bite, a.k.a.
foolish lawnmower accident).
any skin disfigurement on the face — including
rashes — bears a bit of stigma. I think this is because
our faces are our most significant transmitters and
receivers of “body language.” We communicate tons
through our expressions and the way we react to others'
expressions. A facial disfigurement is the
communications equivalent of “noise.”
Allergy stimulated rashes did, of course, occasionally
erupt on my face when I was growing up. They made me
extremely self-conscious as I got older, and there's
probably not a single over-the-counter remedy that I
haven't tried at one time or another. In fact, there may
not be many prescription remedies that I haven't
the time I moved to Kentucky it had been years since I'd
suffered a bad rash on my face. Those that did emerge
usually did so under the beard, which I started to wear
in the early 1980's and have worn — with the exception
of a few months — since. I was, therefore, both
surprised and chagrined to notice “a rash” emerging on
my forehead and — the worst possible place— on the end
of my nose.
course, my first reaction was to blame this on
allergies. “I should have known,” I said to myself,
“that my allergies weren't going to ignore my presence
in ‘the allergy capital of the United States.’”
my historically‑known‑to‑work over‑the‑counter remedies had
apparently no effect on my facial rash, I finally relented
and went to my first derm in Lexington. I remember the
occasion well. The doctor was a young woman — couldn't have
been more than a year or two out of school. Her diagnosis
was that the nose problem and the forehead problem were two
different things. She was willing to attribute the forehead
problem to allergies — probably because I was so cocksure
that's what it was. But she frowned and squinted and scraped
and ran off to examine bits of my nose under the microscope.
Then she scared me to death. “This could be cancerous,” she
wasn't that pleasant news!
significant wailing and gnashing of teeth (on my part) she
recommended, and I gladly concurred, that before we jump to
conclusions we should try to freeze (i.e., “kill”) the
affected skin on my nose and see if healthy skin grew back.
“freeze” the skin on my nose she used a super- cooled gas (I
believe it was hydrogen [see Postscript, below]) that
she squirted on my nose in bursts from what looked like a
fancy aerosol can. She said it would sting. It didn't.
forehead she prescribed a mild corticosteroid cream — one of
those used as a more or less universal ointment for rashes
and other mild skin irritations.
she told me to come back in two weeks.
returned to normal in a handful of days — much to my relief.
My forehead was also considerably improved by the time I
returned two weeks later. The young derm and I smiled at
a true Kodak moment.
month or so after that, I looked like Rudolph the
Reindeer, again — with a red bandana across his forehead.
And now I was getting desperate; trips to go on, new people
to meet, and all this “noise” interfering with my main body
third visit to the young derm was anything but a Kodak
moment. I ranted and raved, she frowned and — I'd swear —
almost got weepy eyed. That's when the word “psoriasis” was
mentioned for the first time. She was beginning to think the
forehead might be psoriasis, and she wanted to freeze my
her freeze my nose again and, fortunately, again it cleared.
She prescribed a different — but still low‑potency —
corticosteroid cream for my forehead, and again it cleared a
little. So I went off on my travels doing the best I could
to conceal the forehead by combing my hair low and grateful
that my frozen nose was, at least for the moment, more or
less normal looking.
week or so after I returned to Kentucky the nose was red and
bumpy again, and the forehead lesions were crimson. I
decided it was time to go after a bigger gun.
called friends and obtained referrals and finally made an
appointment to see another derm — this one with a
reputation, a man “known about town.”
derm pulled no punches. He said it was all psoriasis.
He prescribed yet another cream and a thrice daily regimen
years that have passed since then, I've learned how to keep
the facial lesions under control. The nose, forehead, and
two lesions under my beard on either side of my chin, when
they are not flaming, get treated once a day with a mild
corticosteroid cream. When the lesions begin to flame (i.e.,
turn red) they get treated three times a day.
battle now is not to get rid of the facial lesions, because
no one knows how to do this, yet. The battle, now, is simply
to keep them quiet and as invisible as possible.
about three years of being able to control my facial
lesions, I was “pressured” into shaving off my beard. That
warrants some explanation. My beard contains a lot of white
hair. Most people concur it makes me look five to ten years
older than I am. I was forty-three the last time I shaved
clean and strangers were guessing me to be in my “late
forties or early fifties.” The problem was being compounded
by salt and pepper grey showing up in my hair, too.
honest with you, I didn't view any of this as much of a
problem until, at age forty-three, I found myself single
again. Suddenly, all the white and grey made me look
“distinguished” to women in their late forties and beyond,
and “extinguished” to any female younger than I was. For
awhile, this didn't bother me, either (after all, both my
former wives had been older than me, one by four months, the
other by two years). One would say I “rather fancied” mature
when you are forty-three and suddenly find yourself single,
and by virtue of your appearance any woman younger than you
calls you “Uncle Ed,” you begin to wonder.
time I “came clean” (i.e., lost the beard) I was dating a
fifty-five year old, a fifty year old, and a forty-seven
year old. I was wanting to date two thirty-five year olds
and two forty-two year olds, but these four youngsters were
the ones who referred to me as “Uncle Ed” (the
evening, fortified by copious quantities of self pity, I
took the scissors and the razor to my face and revealed . .
. a much younger man with two hideous psoriatic
lesions on his chin!
cloistered myself away for two or three weeks while I
attacked the lesions with my potions and unguents.
Eventually they stopped flaming and the resultant
discoloration was such that I figured they would be
unnoticeable in dark, smoke filled nightclubs. Even so, the
older girlfriends were horrified to be seen with me — not
because of the psoriasis, but because I looked about the age
of their sons. The youngsters couldn't cope with the fact
that this man, who had been their kindly Uncle,
suddenly showed up looking like a suitor.
retrospect, I see that it was a healthy, life changing
exercise. Three things came of it. One, I immediately grew
the beard back. Two, I threw away my “little black book” and
bought a new one with all blank pages. And three, I now tend
to those chin lesions — though they be hidden under my beard
— with as much dedication as I do the rest of the face
lesions because, who knows, there may come another day when
vanity drives me to shave away the mask.
Ed’s Postscript (1/5/2008):
relationship must still be controversial among health
scientists, because drawing connections between the two is
still resisted. The obvious “connection” is the immune
system, but right now our position relative to the immune
system is somewhat similar to treasure hunters finding the
biggest cache ever. Our science has managed to open doors
but what they see inside is overwhelming and suggests years
of work to truly fathom. It seems like
everything is connected
to the immune system in some way. The immune system is acted
upon and acts upon everything. That being the case, you
might argue that hang nails and psoriasis are related
(which, come to think of it, would be an easy argument if an
aggravated hang nail became a psoriasis lesion in accordance
with the Koebner Phenomenon). The point is, things “trigger”
allergies and things “trigger” psoriasis. Are they the
same things? Maybe. Is there a confluence of the two,
allergies and psoriasis, that suggests research in one might
yield treatments for both? Maybe. So far, the greatest
number of prescription treatments for psoriasis share duties
to other diseases or conditions. Methotrexate is a cancer
drug, cyclosporine is used to inhibit transplanted tissue
rejection, many biologics were first used for the treatment
of other autoimmune diseases including arthritis and
Crohn’s. The specific processes in the immune system that
relate to psoriasis relate to other disorders as well (e.g.,
tumor necrosis factor, a.k.a. TNF). This is a double-edged
sword. We discover new effective treatments for psoriasis
from biologic drugs created to treat other disorders, but
what else those drugs effect isn’t always known, especially
in the long term.
young dermatologist I went to see first used
cryosurgery, using liquid
nitrogen (not hydrogen) to freeze the end of my nose. Since
then I’ve seen the procedure performed on a grandchild’s
warts. In retrospect, I’m lucky the nose lesion didn’t come
back worse than it had been. The nitrogen freezing could
have become a Koebner Phenomenon reaction. Named after the
doctor who first pointed it out, a Koebner Phenomenon is the
emergence of a psoriasis lesion at a place on the skin
previously traumatized through some other action. When I had
my appendix taken out in ’93, the incisions Koebnerized. My
new derm was so tickled by this he took photos.
it stands, psoriasis on my face — forehead, nose, under the
beard — has been the easiest for me to treat successfully
with topicals. The only topical I’ve been
prescribed for my face is
Westcort® cream, a name brand version of
prescription-strength hydrocortisone, a category 4 (weak)
steroid for dermatologic uses. (It was also prescribed for
use on my genitals.) When I needed fast clearance, I used
stronger topical steroids “outside the limitations of
prescription instructions.” I don’t advocate doing this, and
I haven’t had to do it often. But I HAVE done it.
scalp and face lesions have also responded quickly to
systemic therapies. For me these have been
among the biologics,
Raptiva and Humira. Since starting the systemic
therapies, I’ve not had bad face or scalp flares — something
for which I am very grateful. The face lesions did major
damage to my self-confidence and scalp lesions were, without
question, the most distressing I’ve ever experienced because
of the insatiable itching.
regard to the girlfriends: the year was 1995, a year I
identified earlier as my “year of living dangerously.” Two
good things came out of those experiences. First and most
importantly, I met and wooed my current wife, Clara. In my
heart she rose to the top of the list and restored my faith
in life-time commitment. The second thing, which in
retrospect becomes a very distant second thing, I learned
that psoriasis need not mean the end of intimacy. In fact,
it can mean just the opposite.