Why skin?

I find skin fascinating. It's so fragile, so self-willed and yet so amenable to care. I see a lot of patients with skin problems in my everyday practice. I find that skin seems to have a direct connection to that part of your brain which deals with self-respect. At the end of the day, much of my effort goes to help people literally be comfortable in their own skin-forgive the pun!

I've this patient of mine, lets call her Veda, who is really very pretty. She came to me when her skin was pretty much ravaged by improper medications and unwarranted use of the same. She was desperate, and on her own admission had stopped going out because she felt her skin was not good enough to be 'seen in'.

Now, one thing I've noticed about most patients in general, is that they want a deadline for their problem--no matter they've had it for years. And with time, I'm sort of a pro at answering that. I start with getting them to clarify how long they've had it so they get that time frame out in the open. Then I give them a time limit which is at least a good quarter more than it would realistically take for them to see a difference. And I tend to give them expectations which are always a little less---so that when they see a difference they'll appreciate it a little more. Voila! Everybody is happy.

So, getting back to Veda. Veda showed dramatic improvement--literally in half the time I predicted she'd see a difference. And having a naturally good skin helped. Yet for all that she unfailingly focussed on a longstanding pimple mark (it couldn't have been more than a millimetre in diameter) , over her left eyebrow. Her agony over it was palpable and despite all my assurances to the contrary, she would not be pacified enough to let it not overshadow her natural confidence. I'd finally had to resort to an expensive laser procedure to help her get rid of it. She would have none of the 'give it time, it will improve' talk.

Which made me question the ethics of the situation all over again. Am I warranted in using a procedure, an expensive one, which can have its own set of side-effects, on her? Did desperation and her obvious lack of self confidence count as motive? Should I have sent her to a counsellor? At the end of the day, did the fact that I helped get rid of her problem and dramatically improve her self-respect issues , count? In the long run, Veda is a surprisingly common example. She is only one in a group of young people, all mostly very good-looking individuals and remarkably confident to all outward appearences --- but every mole on their skin is a literal mountain in the mirror.

Just like sex education or sports, I feel children should be given classes in building up their confidence. There should be teachers and counsellors to help them figure out the causes for their insecurities and above all they should know that the dermatologist shouldn't be the only one around to help them see themselves as prettier people.