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Hands at Halloween
by Ed Dewke
posted <January 1998

Hadn't realized how bad my hands had gotten until I washed them this morning. Lukewarm water hit the five fresh fissures on my right hand and woke me up smartly. Yes, I'd noticed the lesions thickening, the flakes forming, and the thought had crossed my mind for the past three or four nights running that I ought to wear the food handlers' gloves. But these have been cold nights ... cold and cuddly nights and, quite frankly, the thought of plastic coming between me and my beloved's warm torso was too much. Never mind that she's dutifully noticed the flaming coming on and said, without fail, "Don't you think you should wear the gloves tonight?" I also know that she doesn't love the gloves any more than I do.

It's fall, my favorite time of year. I'm a sweater kind of guy and the saddest day of my year is that late Spring morning when I close the cupboard door on all those sweaters. My happiest day is that crisp early Fall morning when I open that cupboard again. These are little pleasures the antagonisms of psoriasis haven't negated for me. I flame mightily when the cold weather sets in ... but it just can't stop me from enjoying it.

Last night the whole family sat out on the deck at sundown—my two step-daughters, their husbands, my two three-year old granddaughters, my three-month old grandson, my wife and I, and we carved pumpkins into jack o'lanterns for Halloween. I assiduously worked my trusty Swiss Army Knife through the pumpkins and felt those lesions on my carving hand stretch and yawn and probably crack, but it didn't prevent me for an instant from loving every moment of our family time in this brisk first Autumn on the farm.

Now I have to call my pharmacist and reorder my oral antibiotics. My derm has instructed me to take the antibiotic whenever lesions crack. I appreciate the wisdom of this, especially with regard to the skin on my hands: they're understandably given to invasion by infection. And if that happens, if I let the psoriasis-cracked skin on my hands become infected, I have let the disease's insidiousness win. Just as people with AIDS die not from the HIV, but from the sundry other atrocities the HIV allows to occur, people with psoriasis suffer more from what it allows to occur than they do from the psoriasis itself. The psoriasis is not an infection, it is a breakdown in the immune chain that eventually allows infections which might not otherwise happen. When I don't take the antibiotics as instructed I will probably get an infection. I watched this happen a couple of times, attuned to the irony at work in my own screwed up pathology.

The psoriasis lesions are, as we know, areas of skin being treated by our immune systems as if they were damaged. Blood invades the area much more frantically than it would if it understood damage control was not in order. This causes the redness of the lesions. Our cells get shifted into regenerative overdrive, multiplying many times faster than normal. This causes the initial thickening of the lesions (i.e., raised skin). Skin grows from its bottom layer up and that uppermost layer which actually meets our environment is essentially dead already. At normal growth rates, this dead upper layer is slothed off cell at a time and we don't notice it. But the hyper rate of psoriatic skin growth causes the outermost layer of dead dermis to turn into scale—i.e., flakes. As these piles of flakes thicken they turn white because they're dead and cutoff from the blood flow. Another aspect of the extra thick, hyped-up skin has to do with its elasticity. The thicker it becomes, the less elastic it is, so, when it's bent beyond its new limitations, it cracks. And that is the point at which my own observations become ironic.

If my skin is ALREADY in a falsely posited "fix-it" mode, I thought, a wee crack and bit of infection should be hastily overcome. No? NO. It seems the psoriasis that drives all that frenetic damage control activity has no steam left when real damage control is in order. It's as though all my system's warriors are deployed on a fake mission then, when the real enemy shows up, they're too preoccupied.

I imagine the germs slinking into my skin cracks, looking at each other, scratching their germ foreheads and commenting, "We're crashing a party here, guys!" While my germ fighting troops are whooping it up around make-believe battles, the enemies wander in, help themselves to the punch and cookies, and blithely set up housekeeping with little or no resistance.

I knock my knuckles against the mirror above my bathroom sink for two reasons: One is to get the smarting from the lukewarm water to stop; the other is to wake up my infection fighting troops. Get wise, guys! I command them. But when it's Fall, and I'm otherwise happy, all lines of communication are down. My frantic skin lesions pay no attention to me, so I will hold my smarting hand gingerly in the folds of my new-found sweater and check to see if the jack o'lanterns weathered the frost without withering....

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