Sunday, July 1, 2012

Dear Doxy

Heat Rash
Contrast enhanced to highlight toe rash, which does not photograph well. The toe rash is shy?

Before coming to Kenya, I had declared my intentions to not take anti-malaria medications.*

*It has just occurred to me that I start a majority of my blog entries with a prepositional phrase. Cale has also pointed out that I split an infinitive. So there is that.

We never took anti-malarials during our three months is SE Asia and were fine. I never got dengue in Samoa either. I was utterly convinced that I had wonderful mosquito-bite avoidance techniques. I was also insistant that Africans live in Africa all the time and don't take anti-malarials all their lives. Of course, people pointed out to me that they also die of malaria.

There were two reasons I did not want to take anti-malarials.

  1. I listened to an archived This American Life about a Fulbright Fellow who lost time and had complete amnesia after having a sort of psychotic break caused by his anti-malaria medications.
  2. I didn't like the idea of taking long term a medication that is not recommended for more than four weeks with out the risk of liver or stomach damage.
Dr. T was particularly unhappy with this decision. To appease her, I asked about anti-malarials during our interview with the nurse in the IU Travel Clinic. This was when I discovered that the medication that Dr. T takes (and was recommending) is a rather common antibiotic that I had even been on before. I took it for my boils in Samoa. Apparently, you don't have to take the ones that are also hallucinogenic. 

And so, I agreed to take doxycycline every day for four months starting the day before we arrived in Kenya and ending a month after we get home. 

One point that Dr. T kept making was that doxycycline makes you more susceptible to the sun and that you will have to wear more sunscreen and cover up more. I completely dismissed this. I figured, hey, I was on this drug in Samoa and didn't have any sun problems. I also figured, eh, more risk for sunburns?  I am a redhead that rarely burns, what's the worst that could happen, I become like a regular redhead?

This was a mistake.

As it turns out, the more susceptible to the sun is not just you will burn faster or more easily. It is you will get a random painful itchy rash in random places on your body. Say, for example, on the tops of your toes (even under the nails) and the tops of your hands (mostly on the knuckles) and no where else.

As Wikipedia explains, "An erythematous rash in sun-exposed parts of the body has been reported to occur in 7.3 [to] 21.2 [percent] of persons taking doxycycline for malaria prophylaxis. One study examined the tolerability of various malaria prophylactic regimens and found that doxycycline did not cause a significantly higher percentage of all skin events (photosensitivity not specified) when compared with other antimalarials. The rash resolves upon discontinuation of the drug."

So I am in the lucky seven to 20 percent. I always knew I was special.

I suppose the toe rash is my own fault. I did ride the four hours up to Eldoret in sandals. With the tops of my feet facing up at the sun the entire time. I also had our frame backpack on my back with our supplies for our overnights in Eldoret and in order to balance myself on the bike, I leaned forward with my hands on my knees. So the tops of my hands also faced up at the sun for four straight hours. I learned my lesson and when we took the bike to Mbakalo (more on that later), I wore socks with my sandals. There are just some situations in life where you have to forego style I suppose.

The rash actually persisted for two weeks or more. I finally bought some hydrocortisone and that seemed to speed up the healing process. My right hand is still dry and scaly feeling and still itches occasionally, but in general I appear to be rash free now.

More on the rest of the Eldoret trip to come.

— Sara

1 comment:

Anonymous said...

Thanks for sharing this with a picture. Your toes look just like mine have for the last week. I take doxicycline everyday for acne, but have never had this happen before...just in time for summer sandals.