Man’s persistent rash seemed ordinary, but it was actually ominous

Owen Freeman/For The Washington Post - For six miserable years, software consultant Ed Williams battled a disfiguring skin rash that doctors thought it was severe psoriasis. Later diagnosis was far more ominous.

No big deal, software consultant Ed Williams thought, when he developed an itchy red rash after playing in a golf tournament in the summer of 2004. Williams suspected he’d wandered too close to a patch of poison ivy or touched something that had triggered an allergic reaction. “I figured it would just clear up,” recalls Williams, who lives in a suburb of Rochester, N.Y.

But when the rash on his arms, legs and back persisted, Williams, who had not had skin problems previously, consulted a dermatologist. The doctor initially told him he had contact dermatitis, a common skin condition triggered by a variety of irritants. Doctors later decided his problem was psoriasis, which causes scaly skin and intense itching and can appear suddenly.

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Contending with his inflamed and often painful skin condition, along with numerous futile efforts to treat it, would consume the next six years of Williams’s life. Nearly two dozen specialists were unable to figure out why the rash, which periodically spread to his face, would sometimes get better but never entirely disappear.

In the end, its unlikely cause turned out to be far more terrifying than Williams ever imagined. Subsequent treatment not only swiftly cleared up his skin, it also saved his life.

The case also left an indelible impression on Brian Poligone, a University of Rochester dermatologist and the ninth specialist Williams consulted, who finally figured out what was wrong. “It’s a really incredible story . . . and will be one of those cases that I bring up in my career,” said Poligone, 39.

No sweat

Williams, 54, said he felt reassured when the first skin doctor gave him a topical cream. “This should take care of it,” he remembers the doctor telling him. But five months later, when various medicines had failed to eradicate the rash, he consulted a second dermatologist.

“He worked on it for probably a year trying different things” that didn’t help, Williams said. In January 2006 he began seeing a new dermatologist at the University of Rochester School of Medicine for “recalcitrant dermatitis.”

Williams said that the rash would leave dense clusters of small, painful blisters on his back, underarms and groin — any place he sweated. Even his feet were sometimes affected. “I tried not to sweat,” he recalled, and increasingly avoided even golf and yard work.

At its worst, the oozing pustules blanketed much of his face, sometimes causing his eyes to swell nearly shut. “I had to use a warm washcloth to open my eyes” in the morning, he recalled, and shaving was impossible. During such times, Williams said, he also tried not to schedule business meetings or travel, which was especially difficult when he was in negotiations to sell his company.

“It was brutal,” he said, although “most people didn’t really know what was going on unless it was on my face.”

Treatments with ultraviolet light, a mainstay therapy for a variety of skin ailments including psoriasis, helped because they made his skin less sensitive and painful. But none of the medications — steroids, antibiotics and even big guns such as methotrexate, which is used to treat cancer, and Cellcept, a drug to prevent rejection in transplant patients — eliminated the rash. Williams underwent several skin biopsies; all seemed to point to psoriasis.

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