Living in Thailand and Having Skin in the Game
Originally posted on September 1, 2015
I have a condition called pityrosorum folliculitis. No it isn’t that Walking Dead viral infection so I don’t believe I’ll turn into a zombie anytime soon, nor is it anything like that terminal disease from Love Story where Ali MacGraw dies in Ryan O’Neal’s arms. Boy did I hate that movie. In fact pityrosorum folliculitis, although a tongue twister, is pretty mundane, but it is the focal point of a good story about the quality of medical care here in Thailand.
So, let’s start at the beginning.
About 15 years ago, when I was still a normal working stiff back in Seattle, I began to develop a skin disorder characterized by extreme itching. At first it was isolated to small areas on my chest and it would go away after a week or so. Sadly it would always return. Later the areas affected began to grow larger and the duration of the outbreaks longer.
Not having a very good health insurance policy at the time I tried treating the outbreaks by checking the Internet, using over-the-counter anti-itch creams, powders, an some Chinese herbal rubs. I even considered prayer. The symptoms would lessen a bit but mostly I would just scratch, and scratch, until there would be a short respite. Soon it would return.
Note on itching: Unless you are also an itch sufferer you probably think this problem is overblown. But if you have one of those skin infections that cause you to itch constantly, scratching until you bleed, then you know what I was going through. The old TV ad that used the term “the agony of psoriasis”, another of those itching diseases, was right on the mark. There were days when it got so bad that I now feel lucky I wasn’t a gun owner. You start thinking that the itch is so bad that maybe just leaving this life and going on to what’s next might be an improvement, no matter where we end up. That’s when you start looking around for a hand gun. Apologies to the NRA but I’m happy I didn’t have one around.
So what does this have to do with medical care in Thailand? We’re getting there.
Things got so bad that I finally made an appointment to see my doctor. I didn’t want to pay that $100 for an office visit; I had a huge deductible on my insurance policy which meant I would have to pay for it all myself. But since I often still found myself searching the house for weapons, I shelled out the $100 instead.
The doctor examined me and then said, “You have a skin infection.” Right! That was money well spent. “I’ll have to recommend you to a specialist, a dermatologist.” He hands me the number, gives me a prescription for anti-itch cream and the $100 disappears.
The dermatologist could see me in 3 weeks. Until then she suggested that I continue on the anti-itch cream.
Note on the medication: On a scale of 1 to 10 my itch-agony was at 10. The anti-itch cream brought that way down to about an 8.5.
Three weeks later I check in with the dermatologist. She examines me for about 45 seconds and says, “You have a case of eczema. There is really not much we can do for that, I’m sorry. Here is another prescription for anti-itch cream. That will be $250.”
And for the next 10 years the anti-itch cream and I got real close. I would have an outbreak of the “eczema” every few months and it would last from a few weeks to a few months. During that time sleep was difficult and during the day I would make those around me uncomfortable enough to take a few steps back hoping not to catch what was making me scratch so hard. I went from applying the anti-itch cream to looking for a lethal weapon to sending up prayers to whoever would listen. That lasted until I got to Thailand.
I was reluctant to go to a doctor here in Thailand because I had already been diagnosed by an American specialist who said there was nothing to be done. But maybe I could get something that would bring my itch-agony down to a survivable 6 or 7. So I walked into Chiang Mai Ram Hospital.
I told the admissions clerk my problem and she said, “Would you like to see a dermatologist?” Sure. The wait was more like 3 minutes than 3 weeks like last time.
I walked into the Thai dermatologist’s office and met up with a guy who looked young enough to be in middle school, with spiked hair, and dressed like a Korean soap opera star. Turns out he was a genius.
I said to him, “I have “eczema” and I was hoping that you could give me something to help the itching.
He told me to take off my shirt, looked at my skin and finally said, “Take a look at this.” And he shows me a picture book of hundreds of kinds of skin diseases. He opens to a page that says “eczema” and asks, “Does that look like what you have?” And I say, “Not in the least.” “You don’t have eczema.” He says. He opens to another page and asks “How about this?” It’s a picture that could be of my own scratched-down-to-the-bone rib cage. “That is exactly what I have.”
“You have pityrosorum folliculitis.” (He had to write this down for me because he couldn’t say it and I can’t remember anything longer than 2 syllables.) “We all have micro organisms on our skin; it is normal and the organisms are usually harmless. But in some people these organisms get into the pores and hair follicles and get infected and the result is intense itching. That is what is happening to you. We can treat it with some oral anti-fungal medication and some cream and in a few weeks it should clear up. It will return because you will always have the problem but as soon as it starts up again you can take the meds again. And don’t worry. It is not contagious.”
I know what you are thinking, but hey, you got those microscopic creepy crawlies on your skin too. Mine just get into places they are not supposed to.
The pharmacy downstairs gave me the meds. Doctor’s fee 400 baht, or about $12. Three weeks later I was itch free.
Now every time I feel a pore or follicle start to itch I scrub the area down with a loofah (always wanted to use that word in a sentence) and an herbal soap to clean out the pores and then I put on the meds and the itch goes away within hours. I have not had another serious outbreak for the last 5 years. And I have stopped looking for weapons around the house, considering suicide, or praying; and people have begun standing just a little bit closer than they used to.
Needless to say I was very happy with my Korean soap opera star of a doctor and have other thoughts about my (expletive deleted) expensive American specialist.
You’ll hear good and bad stories about the medical care here in Thailand. But you can hear similar stories about medical care just about anywhere. I have written about some of my health care adventures in Thailand before, doing so in order to give my readers as much information as I can so that they can make good decisions about their health and health care. My personal experiences here have almost all been positive.
My recommendations: Find doctors and hospitals you can trust. That will be easier in the larger cities. Eat well, don’t overindulge in food and drink, and exercise, and you won’t have to visit that “trusted” doctor very often.
Just in case you are interested in pityrosorum folliculitis.
Good health to all.