18 10.20.19 Photo illustration by Ina Jang
Diagnosis By Lisa Sanders, M.D.
‘‘I feel like my body has been taken over
by aliens!’’ the thin 82-year-old man
exclaimed. Dr. Melissa Iammatteo, the
chief of allergy and immunology at
Westmed Medical Group in Purchase,
N.Y., nodded sympathetically. This was
her fi rst appointment with the older
man, who had come to discuss the itchy
rash that had made his life unbearable.
At his age, he told the doctor, he’d been
through a lot — heart disease, chronic
kidney disease, gout — but ‘‘this was a
whole new ballgame.’’
For the past several years, he told the
doctor, he’d had sensitive skin, thin with
age and easily injured. But about six
months earlier, he began to itch like crazy.
It started with a rash. Big red blotches
suddenly appeared on his chest, belly,
backside and thighs. Right from Day 1,
they were unbelievably itchy. He couldn’t
sleep, could barely read or think. He went
to see one dermatologist after another.
They’d taken biopsies and sent him for
blood work. He was treated with steroid
creams — fi rst strong, then stronger. They
didn’t help. Then UV-light therapy; after
20 treatments, he gave up on that too.
The last dermatologist thought he
might have scabies — tiny mites bare-
ly visible to the naked eye that can live
on the body and cause intense itching,
or pruritus. But despite two courses of
a total-body insecticide cream, the man
was still scratching himself raw.↓
Perhaps an Allergy
The last dermatologist he saw began to
suspect that perhaps it was a skin manifes-
tation of a disease somewhere else in the
body. Two biopsies showed the presence
of eosinophils in his skin. Eos, as they are
known more familiarly, are a type of white
blood cell that can be seen in eczema or
other allergic reactions. This rash clearly
wasn’t eczema — none of the usually eff ec-
tive treatments for eczema had worked.
The itch of scabies is also an allergic reac-
tion, but getting rid of the mites ends the
itch, so it wasn’t scabies. He was probably
allergic to something, but it wasn’t clear
what. She sent the patient to Iammatteo,
an allergy specialist. Iammatteo was well
known for her extraordinary ability to
fi gure out tough cases — even when they
weren’t caused by allergies.
The night before her appointment
with the itchy man, Iammatteo poredThe man was covered with an
unbearably itchy rash, but
dermatologic tests did not turn
up anything. What was it?