"A Blog Post About the Time I Got Psoriasis on My Dick, Diarrhea, and COVID-19," by Jacob Bacharach

Until my senior year of college I had beautiful skin, and then my Ashkenazi heritage caught up with me, the dry cracks and unflatteringly rouged cheeks of all those generations rolling their carts into the Pale of Settlement flew out of my ancestry and onto my face and hands and, worryingly, onto a persistent little plaque on my dick. The student health service at my small liberal arts college couldn’t diagnose it, and I was afraid to go to the small town’s only hospital, which was Catholic, so I simmered for half a year thinking I had contracted some kind of theretofore unencountered STI. Then, home over break, my father, in whom I had confided, and who was himself a hospital administrator with a background as lab tech, gave me an are-you-serious look and told me to go see a dermatologist. There, I dropped my pants and lay on an exam table. He put on his gloves and lifted my quickly vanishing penis, turning it slightly, left, right. He gave me the same look my father had. “You have psoriasis,” he said. “I’ll give you a cream.”

I’ve been fortunate to only ever suffer from a very mild form of the disease over the years, and the little patches that appear on an elbow here, a shin there, have always disappeared after a few weeks of topical steroids, but once or twice, I’ve had larger breakouts across my body—dots and splotches of red that bloom across my legs and back. For these, I have always taken various oral medications. Psoriasis is an autoimmune disorder, but guttate psoraisas, the rarer form of the disease that I happen to have, is often triggered by bacterial infections—I once had an attack after an unexpected adult case of strep throat—or, in my case, by environmental factors. It doesn’t help that I live in Pittsburgh, the grayest, drizzliest city in America.

Such was my luck this year, after a winter of intensely changeable weather and a wild travel schedule that took me on long-haul flights to California, Russia, and Australia over a course of just a few months, that my skin got bad again, and in late February I made an appointment to see my dermatologist, who prescribed Apremilast, which treats certain inflammatory immune responses related to my disease. “Let me tell you about side effects,” she told me. “The good news is, it’s not immunosuppressive.” This was just as news about what we were then still simply calling “the coronavirus” was starting to appear truly dire to Americans. “The bad news is that you’re going to get diarrhea. They say only 20-25% get diarrhea, but I’m telling you, you’re going to get diarrhea.” I said I thought I could handle that. “I’ve gotten great results,” she said.

Several weeks in, I’ve begun to see reports that gastrointestinal distress may be a more common precursor to what we are now calling COVID-19. And, this weekend, after perhaps overindulging in wine during our effective lockdown here in Western PA, combining a hangover with my drug with a habit of drinking espresso instead of water all morning, I even felt briefly faint. Do I have it? I thought, although I had no other symptoms, although I felt better almost immediately after my husband made me drink a bunch of water and Gatorade. Well, I think my skin is clearing, but I still have moments of near-panic, and I am usually a pretty imperturbable guy, pretty fit, rarely sick. Here I am at home: husband, dog, cat, diarrhea, dry skin made worse by constant washing, but otherwise healthy so far. But that’s it, isn’t it? We’re all frail; it’s only a difference of degree.

Jacob Bacharach

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