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Note to Judith from Joel Gallant
Feb 18, 2000


One of my patients tipped me off that you had received a question about soft skin. As you may or may not know, I'm known on the Hopkins Web site for answers that are sometimes sarcastic or satirical. Unfortunately, not all of my readers are capable of recognizing satire when they see it. Perhaps I should be more concrete. (But when I'm too serious, the smarter readers complain.) Anyway, I'm sending you my original answer to the soft skin question (now posted in my "Favorite Question" archive, which I believe was what prompted the question that came to you and no doubt confused you. The same person later wrote back to me later, clearly having believed that I was serious. I believe I corrected that misinformation the second time around. It was good to see you in San Francisco.

Joel (

Here it is:

Since the early years of the AIDS epidemic, AIDS sufferers have been plagued by the ravages of "soft skin," a condition previously only reported to affect the behinds of babies and the hands and faces of fashion models. The sudden appearance of soft skin among young men in urban areas was one of the sentinel markers that drew epidemiologists' attention to this new global pandemic. In some cases, the heartbreak of soft skin drove sufferers to suicide, as it served as a public stigma, announcing their affliction to the rest of the world. Others tried to erase the tell-tale signs with Lava soap and even sandpaper, but the results were short-lived.

There is now evidence that highly active antiretroviral therapy (HAART) can reverse this process, though sometimes at the expense of fat wasting or fat accumulation ("lipodystrophy"). For many suffers, the trade-off is well worth it. "I may have sunken-in cheeks, a buffalo hump, and a pot belly, but my viral load is undetectable, and THANK GOD, I no longer have soft skin," said one patient who was happy with his triple-drug cocktail.

Scientist have not yet worked out the pathophysiology behind the "AIDS-Related Soft Skin Syndrome" (ARSSS), as it is now called. Perhaps at the upcoming Retrovirus conference in San Francisco, or at the World AIDS Conference in Durban, we will gain a better understanding of this puzzling and tragic complication of HIV infection.

Response from Dr. Feinberg

Thanks, Joel, for the belly laugh.


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