Living in Thailand and Having Skin in the Game

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.

20 Responses to “Living in Thailand and Having Skin in the Game”

  1. Barb A nspach said

    Great article, as always. I do believe that commercial referred to the “heartbreak of psoriasis”. I paid a lot of attention to it because I suspected I had psoriasis at the time (I never got it officially diagnosed, and it did eventually go away.)

  2. rmgthatsme said

    We’re thinking of retiring to Chiang Mai in the near future. I read so much negative feedback about the hospitals the being money gougers for foreigners on popular forums. What would be a decent quality hospital at a fair price in CM in your opinion? Thanks for your insight.

  3. wentworthcatherine said

    Great story Hugh. I had something similar happen to me years back. I got seriously ill and went to doctor after doctor, hospital after hospital, to find what was wrong. I sat in doctor’s offices in America, the UK, and France. I took pills that were so strong they changed stuff permanently in my life and not for the better. Finally, I moved to Brunei. With not much hope in my heart, I walked into their broken-down hospital and consulted with a doctor from Pakistan. She gave me a prescription. I paid the equivalent of $4 (Singapore, not US). And within a week I was fixed. Ten years of my life, wasted. All due to incompetence. Googling, I found out later that the fix a standard for what ailed me. These days I’d rather google than put my trust in the medical profession.

    • rmgthatsme, Sorry but I don’t make recommendations, I just try to give as much information as I can. The biggest hospitals in CM are Suan Dok (Sripat) which is the main government hospital. The large private ones (and a bit more expensive but which usually have better and faster service) are Chiang Mai Ram, Lanna, and the recently opened Bangkok Hospital a branch of the one in Bangkok. And there is the missionary associated McCormick Hospital (where my children were born more than 30 years ago). There is also an eye hospital called St. Peter. Most will have some English speaking personnel and I am sure you can find more info with a Google search. I personally have never been “gouged” anywhere. Many of the good doctors will work at both the private hospitals and at the government one. Some people will get a consultation at a private hospital and if there is major surgery they would have the same doctor do it at the government hospital which would be less than half the price.

    • I’m a big fan of Googling myself and have identified many problems. I have found that many doctors are of average intelligence, not geniuses as they would have you think, and have little knowledge of how Nature works. But some are much better than others and I am glad to say that there are many good ones here in Thailand. One just has to look for them.

      Note on a friend and his knee problem: He trusts only one doctor in town, a renowned orthopedist who I know personally and who did hand surgery on my son who was 2 years old at the time. Can you imagine what doing surgery on a tiny 2 year old’s hand is like? It was successful and the doctor has a well deserved great reputation. The problem is that he is over 80 now and sees only 5 patients a week. So my friend has had to wait over a month to get an appointment. And since he is my golf partner I have been without one for a long time now. I am sure that he can find another good orthopedist in town and hope he does, for selfish reasons. I always play better when he plays along side me.

  4. Daniel said

    Thanks Hugh for another insightful post.

    I have a trusted pharmacist that can treat anything small. I jokingly call her “my doctor” as she asks questions about what’s wrong, then gives me what I need and nothing more.

    I also use the government hospital called Maharaj which is a teaching hospital for Chiang Mai University. The wait to be seen can be long, but the price is definitely right. Meds there are also less expensive than an outside pharmacy.

  5. Daniel,

    Yes, the Maharaj Hospiltal is the new name for the old Suan Dok Hospital. There is also another hospital in the same compound called Sripat. It is a bit more expensive but better service, same doctors as Maharaj. (Maha = Great, Raj = king)

    I also make good use of the pharmacists. In the bigger ones they are quite well trained and know their meds and unless they are of the addictive or dangerous kinds (Valium, Viagra, etc.) most are over-the-counter meds and you don’t need a prescription.

    BTW, I get my meds from the hospital when they are prescribed, which is how they make a lot of their money and I want to be a good client. I have been told that the hospital meds are of a higher quality than the ones at the pharmacy. They are usually imported while the others are Thai made. But one should always check things out first. If the quality is the same I go to a pharmacy as it is more convenient and usually cheaper.

    Thanks for the info.

  6. Bruce M said

    Hello Hugh,

    Ahh that reminds me of my favorite palindrome:

    Loofahs in a violin! In a gap in my hymn! I, Paganini!–lo, I vanish, a fool!
    (From the late great Utah Phillips)

    Thanks for a great post Hugh. I have always found that Thai medicine combined with the Thai “Service Mind,” sadly so often lacking among Western health professionals (I am one, and I cringe when I see it, daily.), is a terrific combination. I have had a number of chances to observe this, and am grateful that when I retire I can feel as safe in their medical system as I do in my own.


    • Bruce,

      I remember when Utah Phillips ran for president of the United States. The interviewer asked him, “Utah, you have done so many things in your life, your were a truck driver, a singer, and now a candidate for president. Why don’t you stick with just one thing?” And Utah answered, “My Daddy once told me, when you can do something really well, Why keep on doing it? Go do something else.”

      Great palindrome by the way.

      • Bruce M said

        He had such a great sense of humor. One time at the Vancouver folk Festival I was just a few feet away from him and he sang a bunch of old lefty working class songs, and then sang “Pallindromes” to the tune of Palladin Palladin where do you roam. I love stupid humor sometimes.

        And remember if you feel “stressed” you can reverse it (probably at Swensen’s) with “desserts.”


  7. I had a 2 year chronic itch-fest 25 years back in the USA. The first Dermatologist prescribed a cortisone cream and the itch got worse. Repeated visits got me stronger cortisone creams. Another expert scratched his head and more cortisone came down the pike and by now I was adding a psychologist to the list. Cutting to the chase after being patch tested I was told that I was allergic to cortisone. Now my cure of first and last resort is monkey balm and the itch is nipped in short order.

  8. Dave said

    Thanks for this good information. I do not suffer from any medical issues but recently I’ve experienced this strange itchiness on one small part of my forearm. I’ve tried to ignore it by writing it off to just another of those age-related things that annoy me but you’ve made me wonder if this can be resolved medically. It’s no big deal now but if it gets any worse I’ll be looking for some relief.

    My partner, however, does have a terrible problem with itchiness like the type you describe. She often scratches herself raw during the night. It’s awful because nothing we’ve tried seems to help one bit. I think we’ll be making a trip to Chiang Mai Ram very soon.

    • Dave,

      Lots of luck. It turns out that itching is caused by the same nerves that give us pain. So itching is a type of pain. I’d rather have the other kind. But sometimes painkillers will give a bit of relief.

  9. John said

    Hi Hough,

    Thank you for the insightful post.

    I was wondering since Thailand has a traditional Thai medicine approach to health and illness as well, if you have clinics or doctors that are available for consultations in that realm of medicine, instead of alllopathic western medicine.

    • There are herbalists, acupuncturists, massage therapists (real ones trained at the government hospital) available here, especially in the larger population areas, though I would be very careful in rejecting modern medicine. A good friend of mine, a young and brilliant teacher, had kidney disease and decided that she would take only herbal remedies and avoid all modern treatment. She passed away within a year. Such a loss, and an avoidable one. I have heard that the best is to use a combination of the two. Good luck.

      • Bruce MacDonald said

        This is very sad Hugh. I’m sorry for the loss of your friend. I work in a kidney dialysis centre. Modern allopathic medicine is changing, and including more holistic approaches. In our centre everyone sees not just the MD for meds, but social workers for the emotional and practical life needs, and dietitians to help with adjustments to diet. It’s certainly true that allopathic medicine doesn’t always work, but I completely agree with you that a combination of allopathic and alternative gives people the best chance of health and survival.

        John, rather than “instead” I hope you will consider “in addition to…”

      • John said

        Thanks Bruce and Hugh for your kind responses. I just wanted to gauge what is available in Thailand, in general terms.

  10. john said

    Another thing you may want to research and or consider is how a high starch, sugar, fruit (AKA high carb) diet is primarily responsible for the vast majority of yeast infections.

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