Dermatology as a whole is still seen as a luxury.

April 13, 2018 9:31 AM

"Leviticus says a lot of things, most of which we blessedly don’t have to listen to anymore, if we ever did. But it’s a reminder that attention has always been paid to skin. According to Leviticus 13:3-4, if you had a zit, you were quarantined for a week, and if it was worse, you had to burn your clothes or were kicked out of the neighborhood. If you squint, you can maybe see how fear of infection and disease led to such practices. It’s not fair, but it’s there. Zits have been a sign of not just hormones or genetics, but moral turpitude." Jaya Saxena for Racked, The Classist Implications of ‘Bad Skin’
posted by everybody had matching towels (32 comments total)

Part of Racked's Acne Issue, which also includes:

The Sketchy Reasons Big Pharma Can Charge Over $500 for Acne Face Cleanser
By Cheryl Wischhover

Acne Treatment Used to Include Poisoning Yourself a Lot
By Tracy E. Robey

This Huge Acne Forum Has a Community of 635,678 Members and Growing
By Aditi Shrikant

A Dermatologist Explains All the Ways to Treat Acne
By Cheryl Wischhover
posted by everybody had matching towels at 9:33 AM on April 13, 2018 [4 favorites]

ah yes this is the perfect reading for my regularly scheduled post-lunch obsessive face-picking session.
posted by poffin boffin at 9:40 AM on April 13, 2018 [6 favorites]

I have long felt this as someone with rosacea and (mostly gone) cystic acne. Going out without makeup has had mothers telling their children that I "did drugs", and that is why I have deep red or purple marks on my skin.
posted by kellyblah at 9:41 AM on April 13, 2018 [2 favorites]

Great post!!! I'm so glad to hear that purging is real.
posted by ThePinkSuperhero at 9:42 AM on April 13, 2018 [2 favorites]

There is mounting evidence that both dairy and high glycemic foods that spike your blood sugar quickly (starchy things like white bread and potatoes, for example) can potentially exacerbate acne. = :(

So doing an elimination trial of milk or potato chips for a few weeks can’t hurt. = the fuck it can't! If I have to choose between having acne and giving up cheesy fries, I'm sticking with the zits
posted by ThePinkSuperhero at 9:43 AM on April 13, 2018 [8 favorites]

I was on spironolactone, and my dermatologist didn't tell me anything about purging when I complained about a sudden new crop of chin pimples (not a place I usually got them) after a week or two, thanks for nothing doc.

I know they're talking about acne but wouldn't the lack of dermatologists out there have huge implications for skin cancer too?
posted by emjaybee at 9:47 AM on April 13, 2018 [1 favorite]

I know they're talking about acne but wouldn't the lack of dermatologists out there have huge implications for skin cancer too?

Yep. Public health clinic dermatologists in particular tend to require appointments months in advance, if they're even available in your area, and private practice dermatologists don't have much more availability (though they do charge a lot more.)
posted by asperity at 10:12 AM on April 13, 2018 [1 favorite]

So doing an elimination trial of milk or potato chips for a few weeks can’t hurt.

Anecdotally, can confirm: once I reduced dairy in my diet most of my skin issues went away.

Later learned that I have other mild food allergies that will present as acne. Almonds are the worst for me and will present as cystic. There are lesser culprits as well that present as "regular" zits.

Interestingly, when I now have dairy it's usually goat's milk; I no longer get acne from dairy, but I also consume a metric ton less than I did as a teenager.
posted by vignettist at 10:23 AM on April 13, 2018

I'm an emergency doc. Dermatology is the single least accessible medical specialty. I believe I've gotten them on the phone for a telephone consult twice in 4 years of practice (and, well, they were surprised to take a call from me but quite helpful both times). In my experience, indigent people basically don't have access to dermatologists at all.
posted by killdevil at 10:32 AM on April 13, 2018 [8 favorites]

interesting tidbit about dermatologists being so hard to come by. I had no idea...its another reason I feel incredibly lucky to have Kaiser. I went in a few years ago with what turned out to be a small wart growing on my face. went to my GP, who identified it and then summoned the "roving dermatologist" who is just kinda there, on call, for whatever skin issues or questions might come up. she came right over with the freeze thingy and froze my wart off. (not ready to claim full crone status just yet...) which was nice and all but having a derm available to take a quick look at a weird mole or whatever, during a random visit, could really increase early detection of skin cancers. so many people dont get checked at all and some of those melanomas move fast.
posted by supermedusa at 10:43 AM on April 13, 2018 [6 favorites]

Crikey, during my teenage years I would have been flayed or burned alive, let me tell you. OTOH, at 50+, I have the skin of a well-complected 20 year old.
posted by Samizdata at 10:52 AM on April 13, 2018 [1 favorite]

That's why they always say you can't spell "demonology" without most of the letters of "dermataology..."
posted by GoblinHoney at 11:03 AM on April 13, 2018 [1 favorite]

Crikey, during my teenage years I would have been flayed or burned alive, let me tell you. OTOH, at 50+, I have the skin of a well-complected 20 year old.

Sami, I feel yr pain, I would have been sent to a leper colony as a teenager but yes at 50 Im looking pretty smooth.
posted by supermedusa at 11:09 AM on April 13, 2018 [2 favorites]

I became acutely aware of my class status while I sat in a gleaming, white dermatologist waiting room, surrounded by ads for Botox, microdermabrasion and other aesthetic services, just to get an expanding mole checked out. Who can afford all this stuff anyway? Is this office strictly for rich women? And then the very tall and Nordic doctor looked at my mole, made a face, proclaimed it fine and sent me on my way $160 poorer.

I never want to go to a dermatologist ever again.
posted by Donald Trump Sex Nightmare at 11:24 AM on April 13, 2018 [1 favorite]

I'm a student of photography, and I focus my efforts on portraits.

Here's the thing; most people are acutely aware of their own acne and blemishes, and probably often think they have more than the next person. But when I take pictures of folks, I zoom in on everyone's face (at relatively high magnification); virtually everyone has acne. Virtually everyone. But you don't notice other folks acne unless it's particularly acute. You notice their eyes, their mouths, cues to emotional reactions (as one should).

It's not uncommon for folks that have a bit of an outbreak to not want their portrait taken. I reassure folks, tell them not to worry. Photoshop makes it super-easy to remove acne, which I will do (regardless if they ask or not). I don't retouch people's body shapes or birthmarks, or moles, or anything like that, but a temporary skin blemish which will come and go is something I'll remove. In part because unlike a live person, a still picture will let you really examine a person's face - and you'll notice features that you wouldn't ordinarily. And there's no reason to have a temporary blemish be the focus of someone's attention when looking at a photograph.
posted by el io at 11:32 AM on April 13, 2018 [15 favorites]

My South Asian boyfriend always says that "every time you get a zit, it means someone is thinking about you."

I'm not terribly superstitious, but I'm charmed by that one.
posted by mosst at 11:37 AM on April 13, 2018 [7 favorites]

This is why Dr. Pimple Popper makes me so unhappy. She offers free treatment to people with disfiguring cysts, in exchange for their participation in her videos — that is, their dignity. I’m not here to say that she shouldn’t be allowed to do it when she’s providing treatment options that others won’t. It’s just sickmaking to me.

That, and just, you know, the acne. I loathe my skin so much. My acne scars aren’t cystic; they’re the result of furious attacks. I would flat-out use black salve sometimes, I get so mad.
posted by Countess Elena at 12:13 PM on April 13, 2018 [2 favorites]

I became acutely aware of my class status while I sat in a gleaming, white dermatologist waiting room, surrounded by ads for Botox, microdermabrasion and other aesthetic services, just to get an expanding mole checked out. Who can afford all this stuff anyway? Is this office strictly for rich women?

This is pretty much why I keep going to the dermatology clinic at my local public hospital for my twice-a-year skin cancer screenings. (Melanoma sucks, y'all.) I need to have a once-over, but I really don't need the upselling that goes along with private practice dermatology. I'm plenty self-conscious about my appearance already, thanks, and I appreciate that the hospital dermatologists don't volunteer info about anything that won't kill me (unless I ask).
posted by asperity at 12:22 PM on April 13, 2018 [1 favorite]

I remember dermatology being recommended as a specialty because one's patients never get sick, never get well, and never call in the middle of the night.
posted by emf at 1:33 PM on April 13, 2018 [7 favorites]

"This is pretty much why I keep going to the dermatology clinic at my local public hospital for my twice-a-year skin cancer screenings. (Melanoma sucks, y'all.) "

I asked my physician about skin cancer detection, and he told me about the ABCDE acronym and told me to self examine and inform him if I noticed any problems. Getting twice-a-year screenings sounds like a good idea, but I'm also happy to be able to self-examine with some confidence now (and it might be a great option for those that don't have access to such screenings).
posted by el io at 1:47 PM on April 13, 2018 [3 favorites]

I've been wondering for years whether adolescent acne has been selected for because it looks like a communicable disease, and that tends to afford a safe (or safer) interval between the beginnings of sexual maturity and having to cope with unwanted sexual attention, especially from adults.

And since they tend to disappear in adulthood in some people, I've had similar thoughts about freckles, but the case seems more equivocal.
posted by jamjam at 1:53 PM on April 13, 2018 [3 favorites]

Getting twice-a-year screenings sounds like a good idea

Oh, this is because I've already had the experience of melanoma sucking. Screenings that often isn't generally suggested for people without that history, and may not even be something that merits a specialist. An additional technique to be used in conjunction with self-exams is taking regular photographs of your skin so that you'll be able to notice changes over time.

If you've got a non-internet-enabled digital camera, this is a good use case for keeping it around.
posted by asperity at 2:59 PM on April 13, 2018 [2 favorites]

I've been wondering for years whether adolescent acne has been selected for because it looks like a communicable disease, and that tends to afford a safe (or safer) interval between the beginnings of sexual maturity and having to cope with unwanted sexual attention, especially from adults.

It's an evolutionary trailing trait left over from our primate past when we had hairier faces & needed more oil to condition them.
posted by scalefree at 3:35 PM on April 13, 2018 [3 favorites]

I've been wondering for years whether adolescent acne has been selected for because it looks like a communicable disease, and that tends to afford a safe (or safer) interval between the beginnings of sexual maturity and having to cope with unwanted sexual attention, especially from adults.

I'm not an expert in biology or evolution, but I don't think this is how natural selection works. A condition existing today doesn't mean that it was necessarily selected for. Unless the condition has an effect on individuals mating and passing on their genes, it's kind of irrelevant when it comes to natural selection.
posted by Lexica at 4:03 PM on April 13, 2018 [1 favorite]

"According to Leviticus 13:3-4, if you had a zit, you were quarantined for a week, and if it was worse, you had to burn your clothes or were kicked out of the neighborhood. If you squint, you can maybe see how fear of infection and disease led to such practices."

This is actually a major point of clean/unclean in the Bible, and it has to do with the fact that skin diseases interrupt the integrity of the body by creating entry points for the (ritually) unclean. Similar, mouths are suspect because they allow entry of foreign objects to the body (hence all the concern about clean and unclean food); vaginas are HELLA suspect because they allow entry of foreign objects and bleed for no reason for a week out of every month without the woman ever keeling over dead, very suspicious, and they're a combined entrance/exit which freaks ancient Israelites right the hell out (penises are much safer because they don't admit entry of unclean things, although they can enter unclean places); even ears are a bit dangerous because they can allow entry of unclean words. It's not nearly so much about disease (although a little about disease) as about ritual purity.

You can go a lot into the theology of it, but I think the broader point here is that this metaphysical freaking out about skin diseases/conditions/etc., especially if they involve sores or lesions, appears in almost all ancient religious texts, because humans are hella freaked out by the idea of something being able to get into/under their skin. And I think in the modern world you see this in various guises, such as Morgellon's, people who are freaked out by needles (breaking the skin is profoundly threatening on a visceral level for humans, it's not just that it's sharp or hurty), and people's squicked-out fascination with burrowing insects under the skin and things like Dr. Pimple Popper. Dr. Pimple Popper is so compelling because not only can we vicariously experience the deeply human fear of broken skin / skin with things under it from the safe remove of a screen, but we can watch the comforting, ritualized process by which a priest doctor, in a sterile, clean (which is to say "holy") place restores the individual to ritual purity and fixes the skin thing.

Anyway, tell your kids about how ancient peoples ALSO wouldn't have liked shots because they thought things that broke the skin threatened them with moral impurity and spiritual danger. It distracts them long enough that the shot's over before they remember they're upset about it.
posted by Eyebrows McGee at 6:47 PM on April 13, 2018 [26 favorites]

Crikey, during my teenage years I would have been flayed or burned alive, let me tell you. OTOH, at 50+, I have the skin of a well-complected 20 year old.

Sami, I feel yr pain, I would have been sent to a leper colony as a teenager but yes at 50 Im looking pretty smooth.

Digging hearing from my fellow zitty-teenaged but smooth-middle-aged MeFite brethren and sistren. I had it bad enough as an adolescent that I used to resent that heavily-retouched bastard in my yearbook portraits under my name. I also gave Accutane a try in late adolescence, but gave it up mostly because of the chapped lips; I'm damn lucky that I didn't get some of the worst side effects.
posted by Halloween Jack at 11:13 PM on April 13, 2018 [2 favorites]

> because humans are hella freaked out by the idea of something being able to get into/under their skin.

See also: trypophobia.

> According to Leviticus 13:3-4, if you had a zit, you were quarantined for a week

I'm thinking this is evidence that zits were pretty uncommon when Leviticus was written, unless they were locking up their teenagers for years at a time. Which does rather point to "something in our environment has changed" (eg diet).
posted by Leon at 4:28 AM on April 14, 2018 [1 favorite]

I've been wondering for years whether adolescent acne has been selected for because it looks like a communicable disease, and that tends to afford a safe (or safer) interval between the beginnings of sexual maturity and having to cope with unwanted sexual attention, especially from adults.

I came across a paper from 2004 proposing basically that.

Abstract:
Adolescent acne is considered from the perspective of evolutionary psychology with an emphasis on a role in mate choice. The fact that acne, which is almost universal and not a true infection, is (1) initiated at puberty by the action of pubertal hormones on likely distinct, pro-acne follices, and (2) typically resolves in one’s early twenties when prefrontal cortex development is complete, suggests that the condition’s timeframe is meaningful. Acne’s conspicuous localization on the face, and its ability to elicit reflexive disgust and avoidance in observers, suggests a possible role in sexual selection. The pathophysiology of acne is reviewed, and the suggestion made that, far from being a disease, adolescent acne is a normal physiological process – a high-order psychoneuroimmune interaction – that functions to ward off potential mates until the afflicted individual is some years past the age of reproductive maturity, and thus emotionally, intellectually, and physically fit to be a parent.
posted by gold-in-green at 5:48 PM on April 14, 2018 [1 favorite]

I am an evolutionary biologist, and I'm going to note right here that that paper's abstract cites exactly zero evidence for any kind of selection for teenage acne, heritability for acne, or indeed any information other than observations about modern acne as it exists today. The fact that the journal in question lists itself as the Journal of Medical Hypotheses does not remotely make me feel that the paper is likely to yield any more reliable conclusions than the "what if...." brainstorming conversation here.

I will further note that evolutionary biologists usually don't presume traits are adaptive without some evidence that rules out a neutral null hypothesis, and that the idea of getting peer reviewed publications for a hypothesis with no actual data testing it is frankly blowing my poor little academic mind. We don't get away with that in my field: what a sinecure!
posted by sciatrix at 6:01 AM on April 15, 2018 [7 favorites]

(I also have a paper from an evolutionary psychologist in 2009 in which the gentleman in question argues most earnestly that the human navel is a sexually selected trait, using approximately the same level of evidence indicated in that paper. I'm not optimistic about the level of intellectual quality control in the field.)
posted by sciatrix at 6:07 AM on April 15, 2018 [1 favorite]

> mosst:
"My South Asian boyfriend always says that "every time you get a zit, it means someone is thinking about you."

I'm not terribly superstitious, but I'm charmed by that one."

It makes me sad. Remember me mentioning the well-complected part?
posted by Samizdata at 4:31 PM on April 15, 2018

apparently I am deeply beloved in places that would never even have occurred to me
posted by Countess Elena at 4:40 PM on April 15, 2018 [1 favorite]