Refractory eczema

Eczema had been her only real health problem, but what a problem it had been. 

She suffered persistent diffuse itching that disrupted sleep and made it hard to concentrate. Her skin was liberally decorated with rough migratory patches of varied sizes that she scratched until they oozed. Her skin was so sensitive to chemicals that she traveled with her own toiletries - including toilet paper. She wore long sleeves and high necks regardless of the weather in order to hide the patchwork of thickened skin, hypopigmentation, and active inflammation characteristic of her affliction. Over nearly five years we had struggled to find a solution, starting with basics like over-the counter moisturizers, steroid creams and antihistamines, and ultimately (but unsuccessfully) moving up to a complex regimen of stronger and more expensive prescription versions. Several times a year she presented with acute infected flares that required antibiotics and oral prednisone. She had seen two dermatologists (including one at a tertiary care and out of state teaching center), an allergist, a psychiatrist, and an assortment of holistic alternative practitioners. We had both come to accept it as an unfortunate but unfixable fact of life.

This year when she came in for her annual visit, I noticed immediately that she was wearing a short sleeved blouse, and that her arms were evenly tanned and without any evidence of chronic dermatitis. She noticed that I noticed.

“I’m cured,” she said.

“What made the difference,” I asked, scanning through her electronic record, thinking I had missed a consultant’s note with the answer that had so long eluded us.

“I broke up with Roger.” 

“Was it stress, then? I thought you and Roger had a comfortable relationship. You’d been together since college.”

“No, not stress. Roger and I were fine, but he moved to Caliornia to be near his family, and I’m a Mainer.  No, we parted friends.”

“What, then?”

“Roger was a vegan.”

“A vegan,” I asked?

“You know, no meat or meat products,” she answered. 

“I know what a vegan is, but I don't understand how that relates to your eczema.”

“Oh. After we broke up, I went back to eating meat and stopped eating all that stupid soy. And my skin cleared up in a month.  I even tested it, going back to lots of soy. My eczema came back in a week. Sure enough, I’m allergic to soy.”

Sometimes the diagnosis can only be made by the patient.


 

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