[I wrote the following essay for a medical journal. I’m submitting it here in the hope that it might help some girl, somewhere]
I’d started judging the girls in my class according to the clarity of their skin by the time I was in the eighth grade. Before then other things had occupied my mind, things like which girls were tallest, and who could outrun the boys. But it was in junior high that my friends and I began to lose the smooth skin that had marked our elementary years, displaying instead the blotchy, hormonal foreshadowing of T-zones to come.
For me, there were only two kinds of girls—those with smooth faces, and those without. In a teeth gritting attempt to avoid finding myself in the latter group, I spread calamine lotion on my face before bed each night, sometimes even wearing it in the harsh light of a Saturday afternoon at home, because my mother had told me that it dried out pimples as well as insect bites. I was grateful for this secret remedy and hoped it offered me an edge over those poor wretches whose faces had become relief maps before my eyes.
By the time I reached college my hormones had leveled out and, though I didn’t know it then, my face was the clearest and smoothest it would ever be. When my skin behaved itself, as it often during that time, I turned my attention to other, less pressing flaws like the size of my hips. Only when my face broke out occasionally did I fix my gaze on it again, engaging my old familiar enemy with perverse pleasure. I met my husband during these confident years. My skin even had the decency to glow on my wedding day.
But after the birth of my third baby, I noticed that I’d begun to look like I had a perpetual sunburn across my face. Then, at three months postpartum, my cheeks broke out in scores of tiny red bumps that reached clear into my hairline. I’d never seen anything like them, not even in middle school, but I dismissed them, hoping they were the natural (temporary) result of creating three human beings in less time than it took to get my bachelor’s degree. I bought a drugstore cream with alpha-hydroxy in it to show my skin that we couldn’t go back to the old way of doing things, but that—relax–I was wiser now and less judgmental.
I smeared it on my face one morning while the baby slept. It felt cool and refreshing, as the packaging promised. Three minutes later, however, I knew that something was dead wrong. During that short time my cheeks had bloomed red as plums, concealing their former bumps beneath a creeping, fuchsia wasteland, and under my eyes little water pillows formed so that I stared at my reflection through slits. I curled over the sink and frantically washed the cream off, but it didn’t help. My scorched-earth face remained electric for days.
Two weeks later, when the dermatologist looked at me, he sucked in his breath.
“Oh, you’ve got it, bad,” he said, shaking his head. “It’s Rosacea, but I don’t think it’s going to scar. We’ll try and straighten this thing out.”
I hated him for saying that. I’d suspected it might be Rosacea. Not one to sit at home and let the professionals handle things, I’d Googled every possible explanation for my skin’s hideous new state-of-being, whittling down the possibilities to, a). A prolonged allergic reaction, b). Lupus (why, God?), or c). Rosacea. But in all my research I hadn’t once imagined that my skin might scar.
The dermatologist didn’t help me ‘straighten out’ my newly irritable skin, though not for lack of trying. First he suggested that I smear sulfur cream on my cheeks. When that didn’t improve things, he prescribed a gel that was supposed to reduce inflammation on the my skin’s surface, which, he reminded me, would have to be good enough since there’s no cure for Rosacea. But when I slicked it on, using my ring finger for the lightest possible touch, my cheeks burst into metaphorical flame again.
After topical creams and gels I tried oral therapy, swallowing low doses of antibiotics that gave me yeast infections and made me dizzy. Then I underwent laser treatments that were painful and expensive, and, in the end, left me squinting in the mirror for signs of improvement. After that I became a vegetarian, to the existential sorrow of my husband and chicken-nugget-eating kids, because I read that giving up meat can reduce skin inflammation. When that proved ineffective I decided to fast, going for days on nothing but purified water, to offer my digestion (related to skin!) a rest. But that provided only temporary relief, so I purchased nutritional supplements off the Internet. I swallowed one gargantuan liqui-gel after another, checking ten times a day for signs that my skin was returning to its blessed, occasionally-broken-out state. I saw little change.
This is what I now know: My dermatologist was right; there’s no cure for Rosacea. I’ve been down each quixotic therapy road and its end is the same burning face and a flabby wallet. For ten years I’ve lived with paper-thin skin, skin that can’t handle summer heat, sharp winds, my husband’s three-day-old stubble, my children’s hands. By now I’ve learned to anticipate the onset of neural pinpricks, the ones that light up the surface of my skin just before a spectacular facial flush. I’ve made begrudging peace with the small, red bumps that linger for days after the flush has died down. I’ve become an expert at reading people’s eyes as they talk to me. Has she been in the sun? Does she feel nervous or shy? My morning routine now includes only tepid water and tinted sunscreen. The sunscreen doesn’t offer enough coverage to hide the red underneath, but it’s the best I can do. I glow, but it’s the ghostly glow of zinc oxide.
Sometimes I think about the days when my skin was imperfect like everyone else’s, when the worst thing to happen to me was a pimple on prom night. I’m sad that I didn’t appreciate the normalcy of that time, that I wasn’t comfortable being flawed. It’s too bad, really, because now I’m uncomfortable in a physical way, and I won’t outgrow it. Ten years of managing a condition I can’t hide has finally given me a legitimate reason to think about my skin, and I’m trying not to. If this condition has taught me anything, it’s this: There is no perfect anything this side of Heaven. The pursuit of physical perfection is its own kind of prison.
And we are always the wardens.