The physics of dry Arctic air, eczema, and hives considered as an infectious disease


The North Slope has air that’s so dry

Ice disappears on the sly

     You might grow old

     But you’ll never grow mold

And geese turn to jerky as they fly.

 Synopsis:  I’m a family practitioner from Sioux City, Iowa.  Avoiding burnout, I’m taking a sabbatical while my one-year non-compete clause winds down, having adventures, visiting family and friends, and working in out-of-the-way places.  Currently I’m on assignment at the hospital in Barrow, Alaska, the northernmost point in the United States.

The air in Barrow is clean and clear and incredibly dry.

This part of North Slope of Alaska rates a classification of desert because it receives less than five inches of precipitation (including snow) per year.  As air cools it loses ability to hold water; when it cools enough the water condenses.  A cold window in the winter acquires a layer of dew, or if it gets cold enough, a coat of frost.  The cold Kool-aid pitcher becomes wet when the air next to it cools below the dew point. 

If the dry air of a desert cools below the dew point, the water it holds drops out as rain, fog or, well, dew.  That air, when warmed, becomes positively desiccating as it acquires the ability to pick up more moisture.

The air here sucks water from a person’s body.  It holds so little wetness that windows don’t fog or ice; frost doesn’t form on windshields though the mercury has dipped to twenty below.  Ice changes from solid to gas without going through a liquid stage, via a process called sublimation.

I see eczema literally ten times worse than any eczema I’ve ever seen.

Eczema at home in Iowa would have dry red patches on the hands and cheeks, bad eczema would show on the forearms and calves, perhaps the forehead or the corners of the mouth.  In Barrow those red patches flow together till the entire skin of the patient has turned bright red.  At a large gathering, like the Messenger Feast, I can look around the gym and I can pick out the bad eczema patients, they look like Martians.  The dermatologists who come to the specialty clinics make the usual recommendations for creams and moisturizer, but the patients continue to walk around with bright red faces.

Thus in Barrow I see a lot of chronic (long-term) skin problems, but few acute (short-term) rashes.  Last night I saw a couple.

Urticaria (hives) looks like a bunch of mosquito bites: hard, red, itchy lumps with a white center.  When I was in training, I was taught that it was an allergic reaction to something the patient didn’t know they’d gotten into, and the treatment consisted of antihistamines.

In the years since, I’ve noted that cases of urticaria come in clusters; I’ll see several cases over the course of six weeks, then I won’t see any for months or years.  Ninety-eight percent of the people who come in with hives have the problem exactly once in their lives; the ones who have repeat cases can point to the precipitating circumstances, such as stress, cold, or a particular food.

Thus the problem looks allergic to the patient, but infectious to the population.

Medicine is full of mysteries.

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