Wednesday, August 01, 2007

Baby skin - A patient encounter

It was not the kind of rash you have to lean in to see, but I wanted to get a better look.

When I approached Mluleki to look at his skin, he started giggling.

Soon he was guffawing.

Seven month-olds are usually a little more tepid when I approach them, but Mluleki was not. He was convinced that I was playing with him, and he found our game simply hilarious. His eyes followed me, waiting for the next subtle excuse to burst into gleeful laughter.

He is what I will call precocious socializer.

I am what I will call a clinical opportunist.

Since he was having so much fun, I pretended to play along while actually leaning in further to scrutinize the irregularities on the child’s face and neck.

As I did this, there was little hilarity to be found.

The red bumps were everywhere. In places the bumps were covered with thick golden scabs resembling corn flakes. In the areas that the child could reach and scratch, there were bloody scabs of deep purple. In the middle of his forehead, there was an area where his skin pigment had eroded away from the crusting and scratching. The exposed blush-white tissue beneath contrasted sharply with the skin around it.

Areas that were not crusted or depigmented were raw-steak-like.

Mluleki's face was a mosaic of skin pathology.

But, oh my, how this child did laugh as I examined his pathological, bleeding, dichromatic, caked-over, raw-steak-like skin.

Mluleki may or may not have HIV. His skin tells me that he probably does but final diagnostics are still not back, and, in addition to being opportunistic, I try to be optimistic as well.

With effervescent children like Mluleki in the exam room, this comes easier, no matter how pathetic and sad their inherited afflictions.

Of course, regardless of his HIV status, Mluleki’s skin should get better. It should someday be smooth, scabless, and evenly pigmented. It should someday cease to resemble uncooked beef.

I don’t care how many medicines it takes to make this happen.

A baby deserves to wear baby skin.

Mluleki deserves to laugh beneath a humane complexion.

No birthday suit should be allowed to succumb to such badness before it has seen a birthday.



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