Andropause or hypochondria?
June 6, 2008 6:08 PM   Subscribe

I am about to turn 40, and the last couple years have not been great for me physically, so if this is middle-age, then I don't want it. In my case, the problem is dry skin, which has plagued me more or less all my life, but looking back, it seems like in former decades it was a relatively minor annoyance compared to the scourge it has become. Sometimes I go into an itching frenzy. Not good at night when I'm trying to sleep or when out in public.

In a certain sense, you could consider my question a male version of from last year. FYI, andropause is the medical term for "mid-life crisis" and is like a male version of menopause. In summary, the idea is that for various reasons your hormone levels begin to deviate from normal.

For me, about 2 years ago, at the age of 37, my dry skin started going from bad to worse. Before, my dry skin was made tolerable by simply doing extra dollops of hand lotion on my hands and face throughout the day. I grinned and bore the jokes if it happened to be scented stuff. But now, my skin is dry and cracked and flaky, and regular lotion doesn't help at all and some brands even make it worse. I've been trying lots of different creams and ointments, and have accumulated quite a collection. Then I developed a tenacious jock itch.

The skin between my fingers often erupts in a yellow-crusted rash. Sometimes something similar happens behind my ears, such that if I sleep on one side during the night, then I wake up in the morning with that ear plastered flat to my head.

The dermatologists only seem to offer stronger prescription creams with various side effects. Then they prescribed oral antibiotics which really messed up my digestion. I fired him and went to an Osteopath.

The Osteopath put me on a bunch of vitamin and herbal supplements and told me to avoid dairy and carbs/sugar in favor of protein and fats. She also put me on hormone -replacement therapy (testosterone cream) and oral hydro-cortisone capsules. The jock itch went away, but the rest of my skin is as dry and itchy as ever. In fact in some ways it seems worse and the rash has spread to the backs of my knees. Also, my shins are so itchy I sometimes claw them raw.

I started a homeopathic remedy last month, but the homeopath said it might take a year to work. Sometimes I wonder if I'll have any skin left by then.

The osteopath's next suggestion is for me to see an acupuncturist. Other un-tried suggestions include: 1. buying a $400 cranial-electrical stimulation device; 2. undergoing a $700 genetic test for hormone deficiency.

One thought I've had is to try hypnotherapy because I think I'm "addicted" to scratching myself. Sometimes it feels good (endorphins?). But I almost always regret it--sometimes within a few minutes, although sometimes it isn't until an hour or so later when the pain kicks in.

Another recent symptom is that I'm often cold and hungry in the afternoons: More so than just the snack-cravings from my younger years. These days I find it hard to wait until noon for lunch, and can still pound down quite a lot of snacks only a couple hours afterwards.
posted by markhu to Health & Fitness (21 answers total) 2 users marked this as a favorite
The dermatologists only seem to offer stronger prescription creams with various side effects. Then they prescribed oral antibiotics which really messed up my digestion. I fired him and went to an Osteopath.

What kind of side-effects? Do they effect your quality of life? Do you have pustular psoriasis? No amount of accupuncture or "cranial stimulation" is going to help this. Maybe you need the prescription creams.

No offense, but this Osteopath sounds like a quack to me. It's always a red flag when they want you to buy a bunch of stuff.
posted by LoriFLA at 6:20 PM on June 6, 2008

Sounds to me like you need an endocrine specialist to check your hormone levels, your thyroid function, and so on. IANAD, but perhaps your dermatologists haven't been thinking in terms of a broader diagnosis?
posted by fairytale of los angeles at 6:21 PM on June 6, 2008

yeah, i would fire the osteopath and go back to mainstream medicine. did you ever get a diagnosis from your dermatologists? i would maybe check in with your regular internist, just because there may be something more systemic going on that they will be able to test for (hormone levels, etc.).
posted by thinkingwoman at 6:30 PM on June 6, 2008

I agree with LoriFLA's suggestion about psoriasis--that was my first guess based on your description. You never told us what the dermatologist was treating you for. If that's what it is, and the prescription that scared you was high strength hydrocortisone cream, go back and try it. The whole "may cause thinning of the eyelids" thing is terrifying-sounding, but it really will help the itching, flaking, miserable go away. Once you have it under control, you won't need the cream as much and the terrifying side effects won't be as big a risk.
posted by hydropsyche at 6:49 PM on June 6, 2008

I am not a doctor, just a busybody and frequent patient.

Depending on the diagnosis from the original dermatologist, maybe seek a second opinion from another dermatologist? I had onedermatologist diagnose guttate psoriasis as pityriasis rosea. Saw a new one and la viola, no more rash. A friend had a doc diagnose eczema as a fungal infection. It happens.

For what it's worth, I had eczema as a child and regular lotions did nothing but steroid creams helped (betamethasone). As an adult, my psoriasis totally went away after a while, but in the mean time was managed into non-noticeability with UV therapy and prescription topicals.

Also, your other symptoms. Are you gaining weight with the new hunger? If I were you, I would go back to mainstream medicine (but I do have some biases against homeopathic approaches). Do you have a good GP? Could be unrelated/unimportant, but I would get it all checked out. Time for head-to-toe plus bloodwork stuff, I think. Good luck. Mystery illness is no fun, I know.
posted by Pax at 7:10 PM on June 6, 2008

1. buying a $400 cranial-electrical stimulation device; 2. undergoing a $700 genetic test for hormone deficiency.

Maybe I'm not getting the whole story, but there is no word in those phrases that doesn't scream quackery. My advice: do a little research on your local dermatologists. Find someone that you think you are going to have faith in and stick with them. I know it's hard, but skin conditions like this require *patience.* Dry, flaky skin problems have to do with the life cycle of a skin cell, which is about 21 days normally. So any intervention is going to take *at least* that long to see the effects of. And the best dermatologist in the world may need to adjust therapy a couple of times to get this under control.

Yes, potent topical steroids can have side effects. But the side effects of non-effective therapy are greater, ie clawing your skin til it bleeds or gets infected, not sleeping, and generally going crazy.

I also thought a variant of psoriasis. Also look up ichthyosis. A thyroid condition is possible, but easily ruled out with a simple blood test. Any other thing, particularly hormone related or genetic problems would be total zebra land and I wouldn't go there with any doctor outside of an academic institution.
posted by Slarty Bartfast at 7:18 PM on June 6, 2008

You need to go and get your thyroid checked- the endocrinologist is the best suggestion here. Personally I'd lay off the testosterone too.
posted by fshgrl at 7:33 PM on June 6, 2008 [1 favorite]

A colloidal oatmeal bath may help relieve the symptoms a bit.
posted by Class Goat at 7:41 PM on June 6, 2008

Sounds like what was diagnosed as eczema in my case. I used some steroid creams which sort of helped temporarily and the dermatologist said that I would have it all my life more or less. I started taking evening primrose oil and it has been gone for a year after several years of constant suffering. I recommended it to another with eczema and she had the same experience. The doctor who recommended the evening primrose oil said about half his patents who try it get more or less immediate and total relief and half show no effect.
posted by shothotbot at 7:42 PM on June 6, 2008 [1 favorite]

Really sounds like a chronic bacterial infection to me. Try some over the counter antibiotic cream such as Neosporin overnight on some particularly flaky area such as behind your ears. If it clears up in a week or so, go to a dermatologist with experience treating eczema.
posted by jamjam at 7:55 PM on June 6, 2008

How awful for you! Can you get into a really good dermatologist, an "expert," maybe someone at UCLA? Someone who really specializes in chronic skin conditions such as psoriasis, eczema, etc. (Here's the link to the UCLA psoriasis clinic -- even if they conclude it's not psoriasis or eczema, they may have good ideas about what it is.)

My life with psoriasis has changed dramatically for the better since I went to the UCSF psoriasis clinic. I had previously gone to several well-regarded dermatologists in private practice who prescribed ointments that did absolutely nothing to help me.

Also -- once you have a definitive diagnosis, something that seems correct to you, you can go on line and find a listserv of people who have that condition. That may help hugely, in my opinion.
posted by ClaudiaCenter at 8:29 PM on June 6, 2008

markhu: The dermatologists only seem to offer stronger prescription creams with various side effects. Then they prescribed oral antibiotics which really messed up my digestion. I fired him and went to an Osteopath.

Have faith in western medicine, put that $400 'cranial-electrical stimulation device' fund into another meeting with a dermatologist. From your description your skin is in as bad a condition as it ever has been since you've said farewell to the creams and dermatologist.

Jock itch, if you're a scratchy person will persist, it's a very manageable condition if the area is kept clean, dry and dosed with that spray which name escapes me. (Lotrimix or similar?) So I wouldn't really consider that a massive win for homeopathy.

Learn to knuckle/rub your itches rather then scratching them, you're just inflaming the tissue making it all the worse. Teach yourself, if you scratch, work out a little punishment routine that will eventually annoy you enough to prefer knuckling.

Try to work on keeping the moisture in your skin-- don't have too hot a shower as it'll be nice for your skin to keep some of it's protective oils, use a washing gel thats formulated for eczema. Importantly, at the end of your shower, cover yourself in baby oil, you'll trap in all the moisture thats seeped into your skin and hopefully reduce your dryness issues. Pat dry.

But I can't stress this enough, go and see a dermatologist. It might take time (and it sounds like you're willing to wait a year with the homeopathy with no signs of improvement) but if you keep at it you'll be more likely to find a treatment that will work for you. Side-effects might happen, but if you bear them out and your condition improves, you can work with your doctor to find a good quality-of-life balance.
posted by Static Vagabond at 8:53 PM on June 6, 2008

I have psoriasis. This does not sound like psoriasis at all. Particularly since you have apparently used topical corticosteroids to no effect. Get a new doctor.
posted by loiseau at 9:10 PM on June 6, 2008

Is it possible you are having an allergic reaction of some kind?

I eat from a paleo perspective, meaning the only foods that are really good for you are the ones we are genetically adapted to eat. Cooked and raw foods in the form of meats, fish, fruits, veggies, nuts, tubers and etc. You can do a search on the term paleodiet and come up with scads of information.

Possibly you are heavily reactive to something in your diet, possibly dairy, grains, chemicals, transfats or too much sugar. Your immune system can do all sorts of strange things as you age and your body changes. What you could assimilate when younger now is toxic.

For dry skin, try using EFA oils...borage, flax, hemp, evening primose. When I use these oils in my diet as a supplement my skin gets very smooth and feels better. Possibly your diet is lacking in essential oils.

Shea butter is an african clay. Works great, no odor, really saturates the skin with protection. Check it out.

My two cents worth...
posted by diode at 11:19 PM on June 6, 2008 [2 favorites]

Same thing happened to me when I turned 40

Drove me mad for a couple of years, then Zyrtec came to my rescue.
posted by mattoxic at 12:15 AM on June 7, 2008

Try eating more protein, more vegetables, and less refined starch and sugars.

The effect of this kind of regime (which I generally use to keep excess weight under control) on my inclined-to-fungus feet is just remarkable. Before I turned 40, I wouldn't have noticed it. Now I'm 46, it makes all the difference in the world.
posted by flabdablet at 4:11 AM on June 7, 2008 [1 favorite]

If you haven't tried it already, Eucerin is a powerful moisturizer - I recommend the brand name because of some bad experiences with store brands, but YMMV. And absolutely try to add some Omega fatty acids to your diet. Fish oil, flax, etc. You can get them in pill form, eat more fatty fish, or add ground flax to just about anything without affecting the taste much. And definitely go back to a real dermatologist and/or endocrinologist. I suffered from horribly dry skin one winter which completely disappeared when I stopped taking birth control pills. BCPs are obviously not your problem :-) but hormones can certainly mess with your skin.
posted by walla at 7:08 AM on June 7, 2008

I used to get that- it stopped when I did one thing: avoided any product with Triclosan in it.

Also agree with the advice to make sure your diet is chock full of good fats.
posted by gjc at 8:36 AM on June 7, 2008

Conventional medicine may have its faults, but alternative medicine just does nothing. Homeopathy isn't helping you because you're being prescribed distilled water as a treatment. Vitamins won't help because no science has indicated that vitamins are a useful treatment for almost anything but vitamin deficiencies. And on and on and on.

Osteopathy is kind of on the border of alternative and real medicine and the treatments this doctor is offering definitely sound like the previous. Go back to real dermatologists, though if you feel like those you've been getting help from are deficient in some way, consider using a different one.
posted by abcde at 10:05 AM on June 7, 2008

(I'm a primary care physician.) It doesn't sound at all like psoriasis. It does sound a bit like seborrheic dermatitis ("seborrhea"), although not in the usual locations. Also, seborrhea typically responds to corticosteroid creams.

Do make sure your thyroid's been checked (a blood test called "TSH", and it would have to be, oh, at least twice the upper end of the reference range* to be significant).

My main recommendation is: dermatologist. You imply that you've been to more than one. Probably seeing one of those again would be best, whichever one gave you the best vibe.

The osteopath sounds like a quack.

*For TSH and most other quantitative blood tests, there is no "normal" range. The ranges given are just the ranges that include 95% of healthy subjects. It is rather arbitrary. TSH levels just outside that range are only loosely associated with disease.
posted by neuron at 10:38 AM on June 7, 2008

Response by poster: Well, I've been feeling better this week, and I wondered which of these recent changes vs. my skin is doing it?
1. the baby started sleeping through the night for the first time in over a year
2. doubled my dosages of Hydrocortisone and 5-HTP and EFA/Omega-3 fatty acids
3. started Curcumin, L-Carnitine, and polycasanol
4. started taking Melatonine (3 mg) at night
5. started glyconutrients
6. started emu oil (and fresher Aloe Vera gel)
7. tried a stronger cortico-steroid (Fluocinonide) ointment for a couple days
Or was it the mellowing effect of unburdening myself to the AskMeFi hive mind?
posted by markhu at 2:34 PM on June 11, 2008

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