By Dr. Paul Ehrlich
There’s a good reason why Sherlock Holmes remains the most renewable character in drama. There’s nothing like a good Holmes story to reintroduce an audience to the importance of observation and deduction: whether Holmes is played by Basil Rathbone or in more contemporary trappings by Benedict Cumberbatch or even reincarnated as Gregory House, MD, the format remains the same: Holmes sees what no one else sees and draws conclusions no one else draws. End of story. As we say on this website, a good history solves the mystery.
Holmes was based on author Arthur Conan Doyle’s Edinburgh med school professor, Dr. Joseph Bell, who would tell his students details of their lives based on traces of evidence he saw on their clothes, shoes, the state of their complexions, and so forth.
I love it when I can solve the case, although it occasionally surprises me how much some of my colleagues overlook.
A patient came to my office on short notice who looked like she had two black eyes. A dermatologist had given her steroids, which are tricky when used near the eyes. Another colleague saw her when she suspected there might be a nutritional question involved, then passed her on to me when nothing pertinent presented itself.
As I listened to this patient speak, I looked at her hands. She had beautiful nails and I complimented them. She was pleased at the compliment. I asked her where she had them done and she named a salon on the Upper East Side. How long had she been going there? Several years. Always with the same manicurist? Well, as a matter of fact, a few weeks ago, the old one had left. And when did her eye problems start?
Light bulb moment.
I told her to return to the salon and have all the polish meticulously removed, then to get a list of all the ingredients.
This is not 2014 peer-review experimental dermatology. Here’s what it says in Wikipedia:
Irritant contact dermatitis
Main article: Irritant contact dermatitis
Irritant contact dermatitis (ICD) can be divided into forms caused by chemical irritants, and those caused by physical irritants. Common chemical irritants implicated include: solvents (alcohol, xylene, turpentine, esters, acetone, ketones, and others); metalworking fluids (neat oils, water-based metalworking fluids with surfactants); latex; kerosene; ethylene oxide; surfactants in topical medications and cosmetics (sodium lauryl sulfate); and alkalis (drain cleaners, strong soap with lye residues).
Sounds like a “who’s who” and “what’s what” of the mani-pedi trade.
I’ve seen this problem before.
Do I like solving a case? Of course. But I’m no Joseph Bell or Gregory House. These are the little things you learn to look out for. The tissue around the eyes is very vulnerable by its nature. Nothing in the entire body does work that important without much greater protection from skin, cilia, bone, mucosa, and so forth. What would happen if you breathed all those irritants? It might trigger bronchoconstriction, even in those who don’t have allergic asthma. You wouldn’t rub them on your lungs, so why would we let them touch our eyes?
In the words of psychiatrist Buck Mitcherson*, “Don’t get near my eyes.”
*Character created by Mel Brooks for “The Two Thousand Year Old Man.”